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First-time National Council Licensure Examination-Registered Nurse (i.e., NCLEX-RN®) pass rates are important criterion in evaluating the effectiveness of prelicensure nursing programs. This article describes one baccalaureate nursing program's approach in developing and implementing comprehensive, evidence-based strategies to effectively halt a 3-year decline in the program's annual first-time pass rates. Strategies included revisions in student policies related to admission, progression, and graduation; a comprehensive curriculum revision; and faculty development. These data-driven strategies improved first-time NCLEX-RN pass rates from 64.86% to 94.29% over 3 years—a dramatic 45% increase.
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www.journalofnursingregulation.com 11Volume 9/Issue 1 April 2018
Instituting Evidence-Based Changes
to Improve First-Time NCLEX-RN®
Pass Rates
Kathleen Czekanski, PhD, RN, CNE; Barbara J. Hoerst, PhD, RN, CNE; and Jane Kurz, PhD, RN
First-time National Council Licensure Examination-Registered Nurse (i.e., NCLEX-RN®) pass rates are important criterion in
evaluating the effectiveness of prelicensure nursing programs. This article describes one baccalaureate nursing program’s
approach in developing and implementing comprehensive, evidence-based strategies to effectively halt a 3 -year decline in
the program’s annual first-time pass rates. Strategies included revisions in student policies related to admission, progression,
and graduation; a comprehensive curriculum revision; and faculty development. These data-driven strategies improved
first-time NCLEX-RN pass rates from 64.86% to 94.29% over 3 years—a dramatic 45% increase.
Keywords: First-time NCLEX-RN® pass rates, evidence-based education strategies, curricular strategies, nursing education, remediation
Competitive pass rates for first-time takers of the National
Council Licensure Examination-Registered Nurse
(NCLEX-RN) licensure examination are vital for a pre-
licensure nursing program’s reputation and viability. Prospective
students and their parents, community members, and nurse
recruiters evaluate these rates as a key indicator of a program’s
quality and rigor (Mager, Beauvais, & Kazer, 2017; Taylor, Loftin,
& Reyes, 2014). Additionally, accreditors such as the Commission
on Collegiate Nursing Education (2013) and the Accreditation
Commission for Education in Nursing (2017) require that nurs-
ing programs have NCLEX-RN pass rates of 80% or higher to
maintain accreditation. Boards of nursing (BONs) also set bench-
marks for first-time pass rates, often at 80%, and failure to meet
these rates may result in sanctions for the prelicensure program
(Serembus, 2016). This paper describes one baccalaureate nursing
program’s approach in developing and implementing comprehen-
sive, evidence-based strategies to effectively halt a 3-year decline
in the program’s annual first-time pass rates.
Background
This Pennsylvania program consists of a day section through
which students attend classes full-time and a part-time evening
section for adults who are working full-time. The day students are
traditionally young adults who recently graduated high school.
During the last decade, 52% were classified as economically or
educationally disadvantaged, and at least 30% were the first
generation in their families to attend college. When consider-
ing NCLEX pass rates, the students are measured as a single (or
combined) group.
In 2009, the PA BON passed a resolution that mandated
the required minimum first-time pass rate of all state-approved
programs be increased from 60% to 70% beginning October 1,
2009, and to 80% beginning October 1, 2010 (Pennsylvania
Department of State, 2018). In the fall of 2012, the nursing pro-
gram’s first-time pass rates fell to 76.76%, resulting in a crisis
period for the program as it entered provisional approval sta-
tus. In making the PA BON required notifications to internal
and external stakeholders, the nursing program’s administrators
and faculty emphasized that corrective steps would be taken to
restore the program to its full approval status. Several strate-
gies supported in the nursing education literature were imple-
mented immediately, including course content mapping to the
NCLEX-RN test plan and requiring that the Health Education
Systems Incorporated (HESI) exit benchmark score of 850 be
met to pass the senior seminar course. While acknowledging the
need for corrective changes, the nursing program’s resolute fac-
ulty sought to establish data-driven support, using program data
sources, for any proposed changes. The PA BON required that a
Performance Improvement Plan be developed each year that the
program did not meet the required first time pass rate of 80%.
The plan had to identify specific actions that addressed student,
curricular, and faculty factors contributing to the decline.
Despite the program’s immediate response to the initial
decline, the annual pass rate for first-time testers for October
1, 2012, to September 30, 2013, decreased again to 71.26%.
The sense of crisis heightened, and it became clear that a reactive
“band-aid” approach was not an effective way to guarantee suc-
cess for the students and the program. Knowing complex, syn-
ergistic changes would take time to influence pass rates, it was
12 Journal of Nursing Regulation
disappointing but not totally unexpected when the 2013–2014
pass rate again fell below the required 80% benchmark (64.86%).
The dean of the nursing program petitioned the PA BON for an
additional year of provisional approval status to more accurately
evaluate the outcomes related to the NCLEX-RN success plan.
With the additional time granted to the program and the admin-
istration and faculty’s strong commitment to the new policies, the
decline was halted. The annual first-time pass rate in 2014–2015
was 83.33%, the 2015–2016 rate was 87.66 %, and the 2016–
2017 rate was 94.29%. Table 1 presents the annual pass rates
from 2009 through 2017.
Evidence Supporting Strategies in NCLEX-
RN Success Plan
The student NCLEX-RN success plan, originally developed in
2011 and re-evaluated annually, listed the required number of
NCLEX style questions in specific courses, the sequencing and
benchmarks for specialty and exit HESI exams, the required
remediation and tutoring referral guideline (e.g., course test
grade below 80%), and a requirement for an approved in per-
son NCLEX review course. In line with the required PA BON
report, faculty determined the revised NCLEX-RN success plan
would address student policies (i.e., admission, progression, and
exit/graduation), curriculum revision, and faculty development.
The nursing program’s Assessment and Evaluation Committee—
consisting of the dean, program chairs, directors, and several
full-time faculty members—directed the recommendations for
new or revised major strategies using evidence from the liter-
ature and program data sources. These recommendations were
then presented to the Bachelor of Science in Nursing Curriculum
Committee, composed of full-time didactic and clinical preli-
censure faculty, for consideration (Table 2). The first task of the
Assessment and Evaluation Committee was to identify nurs-
ing education best practices for NCLEX-RN success through
appraisal of the current scholarly literature.
Literature Review
A literature search for articles related to nursing curricula and
NCLEX performance was undertaken using the CINAHL data-
base and Summon discovery service. The search was initially
limited to articles published since 2010; however, two articles
published earlier than 2010 were ultimately included because of
their relevance. The following key terms were used in the search:
NCLEX outcomes, first-time pass rate, nursing admission and
exit policies, standardized testing, nursing program progres-
sion, curricular revision. The search revealed numerous reports
of policy and curricular changes and their effect on individual
program outcomes (Carr, 2011; Cole & Adams, 2014; Koestler,
2015; March & Ambrose, 2010; Randolph, 2017). Such changes
have included admission policies, setting benchmark exit test-
ing scores as a graduation criterion, using specialty examinations
throughout the curriculum, and offering or mandating remedia-
tion. NCLEX-RN first time performance was the most frequent
direct or indirect outcome. Other common outcomes included
improvements in clinical skills competency, professionalization,
and critical thinking (Schroeder, 2013). Many studies focused on
identifying program preadmission predictor variables for pass-
rate success (Romeo, 2013; Sears, Othman, & Mahoney, 2015;
Simon, McGinniss, & Krauss, 2013), combined with implement-
ing strategies to improve pass rates after an unexpected or notable
decline (Horton, Polek, & Hardie, 2012).
Systematic and integrative reviews (Pennington &
Spurlock, 2010; Sears et al., 2015; Sosa & Sethares, 2015) con-
ducted during the past 10 years revealed that most nursing edu-
cation studies focused on student preparation or first-time pass
rate performance in relation to NCLEX, and relied on nonexperi-
mental correlational and descriptive design studies. Furthermore,
they were often conducted with small sample sizes and no con-
trol groups, and their data were often collected after numerous
interventions have been simultaneously put into place, making
it difficult to measure the effects on individual interventions. For
example, if a program has increased its academic requirements
for program admission, it is difficult to determine if that change
alone would be sufficient to improve pass rates apart from also
needing to increase progression and exit requirements.
Harding (2010) asked if it is the program requirement of
meeting an exit test benchmark score itself or if it is the reme-
diation offered to help students achieve the benchmark score
that leads to success on the NCLEX-RN. Horton et al. (2012)
and Mee and Schreiner (2016) explored effective use of remedi-
ation strategies for at-risk students, or those who fail to reach
benchmark scores on initial testing. Carrick (2011) and Cole and
Adams (2014) suggested that a multifaceted approach is neces-
sary to promote student success on the NCLEX-RN and outlined
TABLE 1
Trend Data of First-Time NCLEX-RN
Outcomes for Pennsylvania Board of
Nursing Testing Period (10/1 to 9/30)
Outcome by Year Actual % Frequency rate
2008–2009 80% 160/200
2009–2010 82.95% 180/217
2010–2011 85.51% 177/207
2011–2012 76.76% 142/185
2012–2013 71.26% 119/167
2013–2014 64.86% 144/222
2014–2015 83.33% 150/180
2015–2016 87.66% 135/154
2016–2017 94.29% 99/105
Note. NCLEX-RN = National Council Licensure Examination-Registered
Nurse.
www.journalofnursingregulation.com 13Volume 9/Issue 1 April 2018
interventions within several major areas, including academic poli-
cies, curriculum and teaching approaches, assessment of learn-
ing outcomes, and remediation and student support. Serembus
(2016) proposed using a continuous quality improvement model
to address ongoing issues that have the potential to adversely
affect licensure examination pass rates.
Student Policies
After conducting the literature review, members analyzed data
examining graduates’ performance on the licensure examina-
tion relative to students’ performance throughout the program.
In the following sections, we describe how this approach led
to an evidence-based NCLEX-RN success plan that addressed
program-specific student, curricular, and faculty factors while
remaining aligned with the university’s and program’s student-
centered mission, professional nursing standards, and PA BON
regulations for baccalaureate nursing education programs.
Admission
Numerous authors have identified the complexity of predicting
success for prospective baccalaureate program nursing students
based on preadmission academic criteria (Bennett, Bormann,
TABLE 2
NCLEX-RN Success Plan Strategies
Key Areas Major Strategies
Student Policies
1. Admission criteria
Minimum SAT score (critical reading and math) of 1000 (effective for Fall 2014 for direct admission
to nursing major)
Standardized pre-admission nursing test with benchmark performance required for all students with
SAT scores < 1000 (Fall 2014)
2. Progression criteria
Course HESI examinations incorporated as 10% of course grades (Spring 2013)
Requirement for computerized NCLEX-RN practice questions instituted across the program (Fall
2013)
Fundamentals HESI examination added to Fundamentals course (Fall 2014)
Course passing grades raised to 78% (C+) from a 75%“C” (Fall 2014)
Required nursing course semester GPA raised from 2.0 to 2.75 (Fall 2014)
3. Program exit
policies
Required benchmark Exit HESI score of 850 to pass Senior Seminar course (Fall 2013)
Limited students to only one repeat of Senior Seminar course (Spring 2015)
Curriculum
1. Clinical learning
First high-fidelity simulator purchased, SimMan 3G (Spring 2014)
Standardized concept maps developed for use in clinical area (Fall 2014)
Simulation activities required in all clinical courses
New Interprofessional Simulation Center opened (Spring 2016)
2. Curricular content
Mapping of course content to NCLEX-RN detailed test plan (Fall 2012)
Hired consultant to assist faculty to revise BSN curriculum (Fall 2014)
Four science prerequisite courses moved to freshmen year (Fall 2015)
Nursing courses begin in sophomore year in new curriculum (Fall 2016)
Clinical hours increased from 672 to 924
3. Tutoring/
remediation
HRSA grant awarded to launch Strategies for Success Tutoring Center for at-risk students (Fall 2012)
Full-time tutor and retention coordinator hired (Fall 2016)
4. Testing
Testing committee formed to review test blueprinting and item analysis required for each major
course examination; revisions to examinations made based on committee review (Spring 2013)
Purchased Scantron’s ParTest®/ParScore® program for test creation and item analysis (Fall 2014)
Implementation of testing policy, which standardized requirements for numbers of course examina-
tions, percentage of pharmacology questions, and guideline for test analysis (Spring 2015)
Faculty Development
1. Teaching/testing
resources
Test Construction Workshop (Spring 2013)
Resources on effective teaching strategies placed in faculty course on Learning Management Sys-
tem (Fall 2013)
Faculty completed NCSBN item writing course (Spring 2014)
Continuing education programs on concept-based teaching (Fall 2016; Spring 2018)
Note. BSN = Bachelor of Science in Nursing, GPA = grade point average, HESI = Health Education Systems Incorporated, HRSA = Health Resources and Services
Administration, NCLEX-RN = National Council Licensure Examination-Registered Nurse, NCSBN = National Council of State Boards of Nursing.
14 Journal of Nursing Regulation
Lovan, & Cobb, 2016; Serembus, 2016; Schmidt & MacWilliams,
2015). In their systematic review of admission criteria for under-
graduate nursing programs, Schmidt and MacWilliams (2011)
concluded that evidence supports the use of a combination of
factors, rather than a single criterion, to predict graduation and
licensure success. Consistently cited factors include preadmission
grade point average (GPA), prerequisite science course GPA,
SAT examination scores (math and verbal), ACT examination
scores, and prenursing standardized examinations (Bennett et al.,
2016; Hinderer, Dibartolo, & Walsh, 2014; Serembus, 2016).
Prediction of success is further complicated when nonacademic
factors (e.g., essays, extracurricular activities) enter admission
decision making (Schmidt & MacWilliams, 2015).
This Pennsylvania nursing program had formally reviewed
and admitted students to the nursing major at the completion
of their sophomore year since the inception of the prelicen-
sure program in 1996. The Nursing Program Assessment and
Evaluation Committee conducted a specific analysis on data from
SAT scores, standardized admission testing scores (National
League for Nursing Pre-Admission Examination), prerequisite
science GPAs, and overall GPAs. Based on the recommendations
of this committee, the Bachelor of Science in Nursing faculty
revised several program admission policies, including raising the
minimum required SAT score from 900 to 1000 for admission
to the university as freshmen nursing majors. The program also
required a minimum score of 450 on both the verbal and math
sections. Data analysis of the program’s graduates from 2011
to 2014 revealed that combined verbal and reading SAT scores
greater than 900 were associated with success as a first-time taker
of the state licensure examination. Higher reading scores (greater
than 450) were more highly predictive than math scores, espe-
cially among students with English as a second language who had
acceptable combined SAT scores but were found to have much
higher scores in math ability than in reading ability (sometimes
differing by more than 250 to 300 points). This poor performance
in reading comprehension, which is consistent with the findings
of Sears et al. (2015) and Kaddoura, Flint, Van Dyke, Yang, and
Chaing (2017), led to the identification of students struggling
throughout the program and subsequent failure as first-time test
takers.
Changes were made also to the program’s requirements for
the National League for Nursing Pre-Admission Examination,
previously used only for transfer students. The test was now
required in 2014 for all students whose SAT score was below
the minimum required score of 1000. The faculty raised the
benchmark score from the 40th to the 50th percentile compos-
ite score and set a limit of two attempts for a student to achieve
the benchmark score. This strategy of using a standardized test
was in response to some students repeating prerequisite courses
to achieve the required 3.0 overall GPA requirement to enter
the major or completing their science courses at another edu-
cational institution. The pre-admission exam used for the past
decade provided an objective measure to standardize the evalu-
ation of student performance despite various grading scales at
other institutions. A limit of repeating one science course one
time was already in place and continued as students worked
to achieve the 3.0 science GPA for the four prerequisite sci-
ence courses (Anatomy and Physiology I and II, Chemistry, and
Microbiology) required for all nursing applicants. Science GPA
has been shown to be a strong predictor for graduating and for
passing the NCLEX-RN the first time (Bennett et al., 2016;
Simon et al., 2013). The new admission criteria, used for the
freshman class who enrolled in the university in the fall of 2014,
raised the academic credentials of this class.
Progression
Notable progression changes were made within the major, includ-
ing raising the passing course grade from a C (minimum of 75%)
to a C+ (minimum of 78%). Consistent with the literature that
identified numerous Cs as a risk factor for failure (Bennett et al.,
2016; Kaddoura et al., 2017), program data showed that stu-
dents with Cs in their nursing courses were more likely than stu-
dents with higher grades to fail the licensure examination on their
first attempt. Of note, objective test scores alone counted ini-
tially toward the passing score. Grades for written assignments
were factored in only after students reached the required grade
of 78%. The faculty determined that objective testing best mea-
sured student’s course knowledge accurately, matching the find-
ings of Oermann, Saewert, Charasika, and Yarbrough (2009) in
their national survey of grading practices used by nurse faculty in
prelicensure RN programs. When raising the minimum passing
course grade to C+, the faculty also voted to increase the mini-
mum nursing semester GPA for progression from 2.0 to 2.75.
Program data analysis showed that over a 3-year period (2011-
2013), a 2.75 nursing GPA was associated with an 80% overall
student pass rate for first-time NCLEX-RN takers.
Exit and Graduation
Many programs use exit testing in a variety of ways to prepare
students for the challenge of taking the licensure examination
(Harding, 2010; Sosa & Sethares, 2015). Data analysis revealed
that a score of 850 on the HESI exit examination was an adequate
benchmark score for success of the program’s graduates; however,
the number of times students were permitted to take the exit
examination needed to be addressed. Initially, students were per-
mitted to graduate while continuing attempts to achieve the score
of 850. It was clear that delay in testing and repeated attempts
were not fostering success on the licensure examination. As stu-
dents took the exit examination in a senior seminar course, the
faculty determined that students would fail the course if the 850
benchmark was not met in two attempts. Furthermore, the fac-
ulty limited the number of times a student could take the senior
seminar course to two attempts (i.e., four attempts on the exit
examination to reach 850). This change was consistent with the
www.journalofnursingregulation.com 15Volume 9/Issue 1 April 2018
existing policy that did not permit students to repeat any nurs-
ing courses in their major if they had failed the same course twice.
Curriculum Revision
In fall 2014, program faculty started revising the nursing cur-
riculum to increase the number of hours spent in medical-sur-
gical nursing courses. The faculty elected to use concept maps
instead of the traditional care plan as a means of having students
organize their data and improve their clinical thinking skills.
Concept maps are a visual diagram linking theoretical concepts
from anatomy and physiology to client data, nursing diagnoses,
treatments/actions, and evaluation methods (Daley, Morgan, &
Black, 2016). NCLEX program reports were vital during this
curriculum review to identify areas where students’ performance
levels did not meet national performance levels. In addition, the
Assessment and Evaluation committee reviewed summary reports
from subject and exit HESI examinations for content areas that
needed improvement. For example, the NCLEX program report
revealed a specific issue with students’ performance in the “evalu-
ation of the treatment plan” as part of the nursing process. As a
result, an in-service program was held for clinical faculty on how
to emphasize ways of evaluating the effectiveness of treatments.
The Assessment and Evaluation committee mapped pro-
gram course content to the NCLEX detailed test plan and sought
feedback from faculty and students about perceived content gaps.
These content areas (e.g., menopause, blood administration, care
of central venous access devices) were integrated into the appro-
priate courses. Faculty determined that the decline in the pass
rate offered the opportunity for a major curriculum revision. A
consultant reviewed the current curriculum and identified mile-
stones along a timeline for making substantial revisions. Starting
with the alignment of the program’s mission and goals with those
of the university, the faculty worked in teams to address specific
tasks.
Guided by the AACN Essentials for Baccalaureate Nursing
Education (American Association of Colleges of Nursing, 2008),
faculty made major structural decisions including: (a) requiring
the four science prerequisite courses to be completed in the fresh-
men year, (b) starting the nursing curriculum in the fall of the
sophomore year, (c) adding courses in pathophysiology and genet-
ics, and (d) increasing required clinical hours from 672 to 924.
Faculty also strategically developed course learning outcomes,
level outcomes, and program outcomes. Although faculty con-
sidered moving from a content-heavy medical model curriculum
to a concept-based curriculum, a blended curricular approach was
chosen as a result of input from clinical partners and to facilitate
required approvals by the various program, school, and university
curriculum committees. Faculty identified concepts within the
roles of the nurse as care provider, manager of care, and member of
a profession, as well as concepts related to patients, with the focus
on holistic assessment and care of vulnerable populations. Faculty
developed detailed course syllabi with deliberate attention given
to teaching and evaluation strategies that promote success for stu-
dents as they worked toward achieving unit and course learn-
ing outcomes. A matrix was used to show connections between
all course, level, and program student learning outcomes (SLOs),
Quality and Safety Education for Nurses competencies (QSEN
Institute, 2018), and the AACN Essentials (American Association
of Colleges of Nursing, 2008).
In particular, faculty focused on the use of an integrated
simulation plan within the curriculum. Simulation in combina-
tion with traditional clinical experiences has shown improved
outcomes, including performance on graduation exit examina-
tions (Curl, Smith, Chisholm, McGee, & Das, 2016). The pro-
gram purchased its first high-fidelity simulator, Sim Man 3G, in
March 2014. The program has since renovated space within the
school and purchased additional equipment to create an inter-
professional simulation center used for students in every clinical
course. This opportunity, whether it is a scenario using high-
fidelity simulation, role playing, or standardized patients, has
provided students with diverse opportunities to develop critical
thinking and reasoning skills. Simulations, using resources such
as the Laerdal National League for Nursing scenarios (Laerdal,
2018), allow students to develop skills in a safe learning environ-
ment. Scenarios focus on areas such as medication safety, manag-
ing the care of acutely ill adult and pediatric clients, and disaster
preparedness.
Testing Policy
Some programs have reported that implementing a testing policy
contributed to improving the first-time NCLEX-RN pass rates
(Schroeder, 2013). The Assessment and Evaluation Committee
formed a testing subcommittee whose initial purpose was to
review examinations within each major course in the context of
developing blueprints, ensuring the appropriate level of difficulty
and clarity of examination questions, and analyzing results of
item analyses. Faculty workshops were held on standards and best
practices for course testing and examination blueprinting using
the NCLEX-RN categories and Bloom’s taxonomy (Krathwohl,
2002). The program also implemented the use of the Scantron
ParTest/ParScore® program as a means of making test creation
and item analysis more effective.
The subcommittee developed a standardized testing pol-
icy across the curriculum and guided faculty in the areas of item
writing and analysis. Some specific components of the testing
policy included: (a) a requirement for three-unit examinations
and a comprehensive final in all clinical courses; (b) an examina-
tion blueprint before writing course examinations as a foundation
for establishing construct validity; and (c) a requirement that a
percentage of examination questions include questions related to
pharmacologic and parenteral therapies. The evaluation method
in all clinical courses ranged from 85% to 100% objective test-
ing. Previous to the new testing policy, faculty varied the percent-
age allotted to testing versus written papers and assignments.
16 Journal of Nursing Regulation
This change was now instituted to better prepare students for
course HESI and NCLEX-RN exams. Educators have reported
this evaluation trend when developing practices to improve
student success on their licensing examination (Killingsworth,
Kimble, & Sudia, 2015; Serembus, 2016).
The new policy called for all test items to be in the style of
NCLEX-RN questions with approximately 10% of the items in
an alternate format. The testing policy also included a statement
on the appropriate cognitive domain for each semester. In the first
semester of the junior year, 25% of the test questions were written
at the knowledge level and 75% were at the application and syn-
thesis levels. By the last semester all test questions were written
at the application and synthesis levels. All faculty were encour-
aged to complete a National Council of State Boards of Nursing
(2017) online test development and item writing course at the
school’s expense. In addition, faculty received university support
to achieve certification as nurse educators through the National
League for Nursing certification examination. Seasoned faculty
partnered with new faculty to create well-written test questions,
which helped to reduce the chair’s workload and improved fac-
ulty cohesion.
The testing policy included specific guidelines for formal
test analyses using the item discrimination index and point bise-
rial correlation coefficients. Before the policy, the faculty may
have used the percent correct as a criterion to accept or reject an
item. Faculty now reviews the item analyses in groups with the
program chair to prevent any bias and to examine any decision to
accept or reject answers. Test scoring decisions are robust, ethi-
cal, and defensible.
The faculty revised the program’s NCLEX success plan to
integrate the use of the Evolve© adaptive quizzing program as a
means of tracking student performance on NCLEX-style ques-
tions. This standardized approach has encouraged students to
become accustomed to computerized and alternative-style ques-
tion formats. In addition, students complete a HESI specialty
examination for specific courses (i.e., Fundamentals, Mental
Health Nursing, Pediatrics, Maternity, Leadership, and Medical-
Surgical Nursing), the score of which is worth 10% of the course
grade. In the senior seminar course, students use the Saunders/
HESI Comprehensive Review Web-based program with in-per-
son test-taking skills classes, which allows students to self-pace
content reviews and helps faculty set benchmark scores for modu-
lar and comprehensive examinations. The exit HESI examination
is the final evaluation method for the senior seminar course.
Faculty Development
Faculty development included both clinical adjunct and full-time
course faculty. The Assessment and Evaluation committee created
a common course for all faculty on the University’s learning man-
agement system course to provide regularly updated articles on
teaching strategies. This committee also led the policy develop-
ment initiative and assisted faculty in implementing and evalu-
ating new policies.
The provision of tutoring and remediation resources was
one focus of faculty development. A tutoring center was created
for assisting at-risk students and a standardized process for refer-
ral was established. Faculty were asked to first meet with stu-
dents who scored less than 80% on any course test. Subsequently,
faculty could refer students requiring additional resources to
the tutoring center. The center’s tutor and retention coordina-
tor became the dedicated contact for assisting students in need
of help with the exit examination. This full-time coordinator
is a master’s degree–prepared nurse who previously served as a
clinical adjunct faculty member and part-time tutor. She demon-
strated strong student rapport and expertise in test-taking strate-
gies. Students reported feeling supported by the new policies and
perceived that faculty and students were in the quest for success
together.
The tutor and retention coordinator also assumed the role
of coach for students as they prepared for their NCLEX-RN after
graduation. Students who completed the program requirements
and the required in-person NCLEX-RN review course were
invited to attend “support sessions” focused on the effective use of
resources and strategies to reduce test-taking anxiety. This extra
level of support has been very well received and has closed the
gap between program completion and NCLEX-RN preparation.
Discussion
Faculty simultaneously implemented numerous data-driven
strategies to halt the 3-year decline in the program’s first-time
NCLEX-RN pass rates. Policy changes were needed to urgently
improve pass rates; however, the extensive curriculum revision
was a strategy to improve long-term results. The impact of the
revision on the curriculum and admission criteria are yet to be
demonstrated as the first students in the new curriculum will
graduate in spring 2019. On reflection, academic strategies that
had an immediate impact can be attributed to changes in student
progression and changes in exit policies (i.e., limit senior semi-
nar to two attempts; in-person only NCLEX review course. In
addition, faculty identified the intensive personalized coaching to
prepare senior students for the licensure examination as particu-
larly important to fostering success. Graduates have shared their
positive, unsolicited assessments of this coaching after success-
fully passing their NCLEX-RN exam. The tutoring coordinator
developed individualized plans for at-risk students and supported
them in content review, test-taking skills, and emotional readi-
ness. Although time and resource intensive, faculty felt adding
these support mechanisms helped align the needed policy changes
with the mission of the university and the undergraduate nursing
program. Administrators and faculty explained policy changes
in student meetings and letters with support data and asked stu-
www.journalofnursingregulation.com 17Volume 9/Issue 1 April 2018
dents to respond to the challenges in recognizing their commit-
ment to becoming professional nurses.
Similar to the findings of Pennington and Spurlock,
(2010) and Sears et al. (2015) it is difficult to make the connec-
tion between individual interventions when there are a number
of strategies being put into place simultaneously. Carrick (2011)
and Cole and Adams (2014) have proposed that a multifaceted
approach is often needed. The key for programs is to base deci-
sions on evidence supported in the literature and individual pro-
gram data sources.
Evidence-based practice requires collecting and apprais-
ing the most relevant, best evidence; integrating the best evi-
dence while making policy and practice changes; and evaluating
the outcomes of those changes based on the evidence (Melnyk &
Fineout-Overholt, 2015). Unlike a research study where statis-
tical significance is hypothesized as an outcome, this evidence-
based approach established a specific and measureable goal.
Faculty, students, alumni, and stakeholders are proud of the cur-
rent pass rates and the return to full-approval status by the PA
BON, but they also share pride in the program’s evidence-based
NCLEX-RN success plan that addressed program-specific stu-
dent, curricular, and faculty factors. The generalizability of this
program’s NCLEX-RN improvement plan is limited by the lack
of control due to multiple factors being implemented simulta-
neously and a convenience sample representing only students
enrolled in one program. The strategies used throughout the plan;
however, do represent best practices that have been discussed in
the scholarly nursing literature. By integrating these strategies
with program-specific data, the faculty is confident the feasible,
practical action plan is effectively addressing concerns related to
pass rates.
Conclusion
It is clear that no one revision is the key to student program suc-
cess. A three-pronged approach that includes student factors
(admission, testing, progression, and policies), curriculum revi-
sion and faculty development. In the future, faculty systematically
will monitor course and exit exam outcomes yearly, in addition to
first-time NCLEX-RN pass rates, and make changes when appro-
priate. Quantifying outcomes beyond NCLEX pass rates are part
of the next steps in maintaining a robust undergraduate program.
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02
Kathleen Czekanski, PhD, RN, CNE, is Dean, School of
Nursing and Health Sciences, La Salle University, Philadelphia,
Pennsylvania. Barbara J. Hoerst, PhD, RN, CNE, is an Assistant
Professor, School of Nursing and Health Sciences, La Salle
University. Jane Kurz, PhD, RN, is a Professor, School of
Nursing and Health Sciences, La Salle University.
... In addition to large-scale validity research, several single program studies to have also found significant correlations between E2 scores and FTPR on the NCLEX-RN (Cobbett et al., 2016;Czekanski et al., 2018;Havrilla et al., 2018;Homard, 2013;Johnson et al., 2017;Kim et al., 2019;March & Ambrose, 2010). These studies have provided insight into how programs use the E2 to support students' success on NCLEX-RN. ...
... These studies have provided insight into how programs use the E2 to support students' success on NCLEX-RN. For instance, Czekanski et al. (2018) reported using the E2 and HESI Specialty Exams throughout the program. Exam data was used to help evaluate students' strengths and gaps in content areas and develop recommended strategies for improvement. ...
... There is an increasing amount of literature regarding nursing program policies and the use of standardized testing. The majority of the articles focused on how nursing programs incorporated specific policies (Czekanski et al., 2018;Tagher & Robinson, 2016;March & Ambrose, 2010;March & Robinson, 2015;Schroeder, 2013). Randolph (2017) examined programs in the state of Arizona, and there were four articles using national data (Barton et al., 2014;Langford & Young, 2013;Lauer & Yoho, 2013;Stonecypher et al., 2015). ...
Article
Full-text available
Background The HESI® Exit Exam (E2) has been used to assess student readiness for the NCLEX-RN® examination for over two decades. Purpose In this study, we examined the relationship between students' average E2 scores and their first time NCLEX-RN pass or fail outcomes to understand the validity of the E2 as a predictor of NCLEX-RN readiness. In addition, we examined the relationship between policies governing E2 use in programs and success on the NCLEX-RN. Methods Over 40 programs across the United States participated in the study, providing NCLEX-RN outcome information for 3686 students that took the E2 in 2018–2019 and information about policies. Results Students who achieved an average E2 score of 850 and above had a NCLEX-RN first-time pass rate (FTPR) of 96.33%. The NCLEX-RN FTPR was 97.29% for students whose average E2 score was 900 and above. Policies such as test preparation requirements and remediation for the E2 were associated with statistically significantly higher student NCLEX-RN FTPR. Conclusion This study builds upon past evidence about the validity of the E2 and extends research in new directions by demonstrating the role of specific E2 policies in supporting students' success on the NCLEX-RN.
... Preparation can be done through academic stages and nursing professional practice systems in a hospital or community. An online study by Czekanski et al. (2018) showed that gaining competence, theory, and learning experience in practical fields that support the growth and development of professional abilities is needed by every student. Integrating academic education and a nursing professional practice system is a standard curriculum between nursing theory in the academic stage and clinical experience in the professional practice stage (Czekanski et al., 2018). ...
... An online study by Czekanski et al. (2018) showed that gaining competence, theory, and learning experience in practical fields that support the growth and development of professional abilities is needed by every student. Integrating academic education and a nursing professional practice system is a standard curriculum between nursing theory in the academic stage and clinical experience in the professional practice stage (Czekanski et al., 2018). ...
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Background The Indonesian Nurse Competency Examination (INCE) has been designed as a legally defensible, psychometrically sound examination to measure readiness for entry to practice in Indonesia. Purpose This study aimed to explore the predictor factors associated with the nurses passing the INCE. Methods In this cross-sectional study, 727 participants (estimated sample size was 720) were secured using consecutive sampling. The survey instrument, which collected participant demographics and characteristics of institutions, was developed by the research team and underwent testing for validity and reliability. Results INCE pass rate was associated with age (p = .00), grade point average (p = .00), examination status (p = .00), region of the university (p = .00), completion of a standard internship program (p = .001), knowledge about the INCE blueprint (p = .001), preparation for the examination from the institution (p = .011), and taking the national predictor examination (p = .002). The most predictive factor for passing the INCE was the completion of a standard internship program (p = .029; OR = 3.204). Conclusion Completion of a standard internship program was the main factor that predicted whether a participant passed the INCE. Thus, nursing universities need to provide internship programs based on the national standard. Additional research is needed related to other factors that were associated with passing the INCE.
... Negative publicity about the pass rates led to declines in enrollment, and the program had reached a crisis moment. Strategies were implemented within the program that focused on curricular, faculty, and student factors (Czekanski, Hoerst, & Kurz, 2018) with one intervention, coaching, specifically targeted on closing the loop on graduates' preparedness for taking the NCLEX-RN. ...
... Meanwhile, as the nursing program addressed curricular standards and implemented more rigorous progression criteria to address first-time NCLEX-RN pass rates (Czekanski et al., 2018), it became apparent that students needed additional support. In the fall of 2014, the program had its third consecutive first-time pass rate below the state mandated rate of 80%. ...
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Background: First-time NCLEX-RN pass rates are often used to evaluate the effectiveness of prelicensure nursing programs. Faced with pass rates that had declined from 85.71% to 64.86% over a period of 4 years, this baccalaureate-nursing program developed a postgraduation coaching intervention to assist graduates in developing an individualized plan as they prepared for their examination. Method: The intervention was designed to close the loop for graduates on NCLEX-RN preparedness. The intervention, led by the program's Tutor and Retention Coordinator, consisted of cognitive behavioral techniques, content reviews, and test-taking strategies. Results: The intervention has been successfully implemented for a period of 2 years and first-time pass rates rose to 87.66% in 2016 and 94.29% in 2017. Conclusion: Addressing first time NCLEX-RN pass rates requires a comprehensive approach. Students need to begin preparation for their NCLEX-RN examination early in their nursing program; however, this preparation needs to also continue after program completion. [J Nurs Educ. 2018;57(9):561-565.].
... Such strategies include coaching programs, use of standardized exams to identify at-risk students and provide feedback, remediation courses, faculty development programs, and curriculum revisions. [1][2][3][4][5] Additionally, there is literature identifying academic variables including grade point average, standardized exam scores, and the number of course failures and their association with NCLEX performance. [6] While the bulk of nursing literature regarding NCLEX-RN performance reports on pre-graduation strategies, postgraduation mentoring programs have been described as effective in aiding students to be successful on their first NCLEX-RN attempt. ...
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... Czekanski, K., Hoerst, B.J., & Kurz, J. (2018). Instituting Evidence-Based Changes to Improve First-Time NCLEX-RN ® ...
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There is increased interest in reforming the way occupations are licensed. However, most of the current dialogue focuses on the rapid growth in the number of people who need a license to pursue their chosen occupation. Consequently, significant questions are being raised as to the appropriateness of such requirements for groups that do not appear to present any tangible threat to public safety. Recent research has demonstrated that health professions have failed to articulate the need and value for licensure and how health regulators are addressing the many concerns being raised by the current debate. This study identifies dimensions or aspects of nurse licensure congruent with acting in the public interest and starts to curate (ie, to select, organize, and present) evidence related to each dimension, thereby identifying the current impact and highlighting opportunities for further research. This study utilizes a mixed-methods approach that combines documentary analysis, focus group discussion, and related literature associated with the various dimensions of acting in the public interest to highlight how nurse licensure addresses the current drivers for regulatory reform. A total of 99 documentary sources (ie, papers, articles, reports, and opinion editorials) were uploaded to NVivo 11 Plus for analysis. The analysis generated four overarching themes: (a) licensure reform, (b) impact of occupational associations, (c) occupational licensure issues, and (d) contemporary issues. Associated with these themes, 22 subthemes were also identified. The findings demonstrate there is clear evidence to support the fact that nurse regulators are acting in the public interest. However, further research is needed to provide definitive evidence to inform best practices in regulation and to offer direction for improved nurse regulatory reform. Furthermore, it is suggested that nurse regulators create and effectively maintain a global community capable of learning from one another and driving continuous improvement to better serve the public.
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The National Council Licensure Examination for Registered Nursing (NCLEX-RN) replaced the Canadian Registered Nursing Examination (CRNE) in January 2015 as part of the requirements for qualifying for registered nurse (RN) status in all but one Canadian province. This substantial change is likely to have a profound impact on Canadian undergraduate nursing degree programs practices. This systematic review aims to examine the evidence describing the relationship between undergraduate nursing program performance and NCLEX-RN performance by registered nursing candidates as well as other factors contributing to NCLEX-RN success. An initial search of CINAHL and Medline databases using key terms NCLEX and predict, publication dates between 1984-2015 revealed 46 articles of interest. 28 articles were examined for eligibility and 17 articles with clear evidence and descriptions were included. Thematic groupings of academic, cognitive, individual factors and models for successes are presented. The review showed academic factors are strong predictors for NCLEX-RN success. Cognitive factors, particularly critical thinking skills, are correlated with NCLEX-RN success. Stress and highly negative emotions inversely correlate with NCLEX-RN success. Speaking English as a first language showed high correlation with NCLEX success, while other non-academic factors such as age, gender and ethnicity showed varying results. All these factors have implications for nursing programs' practices and students. Research studies need to begin immediately, not only to define and predict factors for NCLEX-RN success within its new Canadian arena, but also to evaluate the outcomes of this exam at baseline and frequent intervals within this population. This will enhance nursing programs' support of students' success.
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Schools of nursing are charged with preparing graduates to meet minimal practice standards upon workforce entry. To that end, students must pass the National Council of State Boards of Nursing Licensure Examination (NCLEX-RN®) upon graduation. Increased rigor and higher recent passing standards for the exam can contribute to declining scores, which negatively impact graduates and the nursing program. The purpose of this article is to describe a successful 10-step action plan implemented to remediate a brief dip in NCLEX-RN pass rates at one university. The plan contributed to a 10 percent increase in NCLEX scores within one year.
Article
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Introduction Few studies have examined the best use of admission data to differentiate between successful and unsuccessful students in a nursing program. Methods Using data from 341 students admitted over a 3-year period, the authors attempted to determine which factors best predicted student success in a baccalaureate of science in nursing, or BSN, program. These factors were used to develop an admission formula that was tested retroactively to determine its ability to differentiate between successful and unsuccessful students. The authors defined student success as passing all nursing courses on the first attempt with a grade of C or above, completing the program on time, and passing the National Council Licensure Examination on the first attempt. Logistic regression for prediction of the probability of success found that the following three variables accounted for 76% of the variance: preprogram grade point average, or GPA, science GPA, and scores on the Health Educational Systems Incorporated Admission Assessment anatomy and physiology subscale. The formula derived was validated by retrospective analysis to determine effect of using this model to select students for admission. Results Use of this model would have eliminated 40.9% of the unsuccessful students and retained 84% of the successful students. Conclusion The formula derived from this study is now being used to select students for the BSN program. In the future, graduation rates obtained by using this formula will be compared to the graduation rates obtained by the prior rational admission process.
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