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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.
Content may be subject to copyright. 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.
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
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. 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.
Numerous authors have identified the complexity of predicting
success for prospective baccalaureate program nursing students
based on preadmission academic criteria (Bennett, Bormann,
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
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
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)
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/
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
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
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.
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 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
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
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
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.
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- 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.
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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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). ...
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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). ...
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%. ...
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. ...
Background and objective: The NCLEX pass rate is considered the primary indicator of program quality. Much literature exists regarding pre-graduation efforts aimed at aiding students to prepare for the NCLEX-RN exam, while there is little available on post-graduation efforts. This project was conducted to identify the post-graduation experiences of successful NCLEX-RN test takers as they prepared to complete the exam.Methods: This was a qualitative descriptive study utilizing a phenomenological framework to determine the lived experience of new graduates preparing to complete the NCLEX-RN exam.Results: Four main themes were identified as relevant to post graduation experiences including: (a) Finding Motivation, (b) Study Tactics, (c) Taking a Break, and (d) The Testing Experience. Additionally, few of the participants took it for granted that they were going to pass the exam, they reported wishing they had spent more time preparing, and with regard to studying, several described wishing they had started earlier.Conclusions: It will be beneficial for faculty to discuss potential strategies for success to utilize after graduation, including expectations of testing day, setting a realistic timetable to test, overcoming lack of motivation to preparation for the exam, and careful scheduling of coaching and study sessions.
... Czekanski, K., Hoerst, B.J., & Kurz, J. (2018). Instituting Evidence-Based Changes to Improve First-Time NCLEX-RN ® ...
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.
Background The NCLEX pass rate is considered the premier indicator of program quality. Nursing programs utilize first-time pass rates (F-TPR) as a basis for making program decisions - especially when confronted with a falling rate. Purpose This survey was conducted to identify the array of strategies implemented to improve or maintain F-TPRs. Additionally, we sought to ascertain whether responding programs had experienced a problematic F-TPR and their experience in the aftermath. Methods This study utilized a descriptive survey of nursing programs. Data analysis included thematic analysis of an open-ended item and descriptive analysis of forced-choice items. Results Nursing programs report F-TPRs heavily influence decisions and policy making especially regarding admission/progression policies, use of standardized exams, and most consider it one of the most influential factors in program decision-making. Conclusion A recommendation is made for changing the requirement to the percentage of students passing within two attempts.
Standardized testing that predicts nursing student success accurately and identifies weak content areas has played a critical role in nursing education. Critics of such testing lament the harm of this type of testing, often misinterpreting common practices as well as overlooking all value. The goal of nursing school is to graduate competent professionals with adequate knowledge to practice safely, who can pass the NCLEX-RN® and gain employment. The use of standardized exit exams or comprehensive exams that are valid and reliable should be embraced as evidence-based, academically rigorous evaluation tools, much like the discipline of education has embraced the Praxis Exam. This paper will present evidence supporting the value of “program exit standardized testing” and address the importance of assessing students and focusing on minimum competency. As a profession that prides itself on the use of evidence to guide practice, we need to use evidence to guide policy development with respect to the use of standardized testing in nursing education.
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AIM The focus of this research study was the evaluation of the effectiveness of using high-fidelity simulations to replace 50 percent of traditional clinical experiences in obstetrics, pediatrics, critical care, and mental health nursing. BACKGROUND Increasing student admissions to nursing programs require additional clinical learning opportunities to accommodate extra students. METHOD Three schools with associate degree nursing programs partnered to identify, implement, and evaluate a creative solution to this dilemma. The resulting quasi-experimental study investigated if substituting half of the conventional clinical experiences with simulations was as effective as traditional clinical activities in obstetrics, pediatrics, mental health, and critical care. One hour of simulation counted for two hours of clinical time. RESULTS Findings indicated combining simulations with conventional clinical experiences resulted in significantly higher scores on the pre-graduation exit exam than traditional clinical experiences alone. CONCLUSIONS Findings have implications for articulation and basic students in associate degree nursing programs.
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For nursing schools to retain accreditation, their students must achieve a benchmark first-time pass rate on the NCLEX-RN® and NCLEX-PN® examinations. Because the NCLEX test is updated periodically, based on a practice analysis conducted every 3 years, and due to increasing required benchmark pass rates, nurse educators are challenged to meet these standards. One evidence-based method, a continuous improvement plan, can help education programs achieve success. This approach provides a way to assess and improve a program from the admission period through program progression to graduation. This article describes such a program and its benefits.
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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.
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.
The use standardized testing in pre-licensure nursing programs has been accompanied by conflicting reports of effective practices. The purpose of this project was to describe standardized testing practices in one states' nursing programs and discover if the use of a cut score or oversight of remediation had any effect on (a) first time NCLEX® pass rates, (b) on-time graduation (OTG) or (c) the combination of (a) and (b). Administrators of 38 nursing programs in one Southwest state were sent surveys; surveys were returned by 34 programs (89%). Survey responses were compared to each program's NCLEX pass rate and on-time graduation rate; t-tests were conducted for significant differences associated with a required minimum score (cut score) and oversight of remediation. There were no significant differences in NCLEX pass or on-time graduation rates related to establishment of a cut score. There was a significant difference when the NCLEX pass rate and on-time graduation rate were combined (Outcome Index "OI") with significantly higher program outcomes (P=.02.) for programs without cut-scores. There were no differences associated with faculty oversight of remediation. The results of this study do not support establishment of a cut-score when implementing a standardized testing.
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.
Relatively few studies have addressed predictors of first-attempt outcomes (pass-fail) on the National Council Licensure Examination-Registered Nurses (NCLEX-RN) for accelerated BSN programs. The purpose of this study was to compare potential predictors of NCLEX outcomes in graduates of first-degree accelerated (FDA; n = 62) and second-degree accelerated (SDA; n = 173) BSN programs sharing a common nursing curriculum. In this retrospective study, bivariate analyses and multiple logistic regression assessed significance of selected demographic and academic characteristics as predictors of NCLEX-RN outcomes. FDA graduates were more likely than SDA graduates to fail the NCLEX-RN (P = .0013). FDA graduates were more likely to speak English as a second or additional language (P < .0001), have lower end-of-program GPA and HESI Exit Exam scores (both P < .0001), and have a higher proportions of grades ? C (P = .0023). All four variables were significant predictors of NCLEX-RN outcomes within both FDA and SDA programs. The only significant predictors in adjusted logistic regression of NCLEX-RN outcome for the pooled FDA + SDA graduate sample were proportion of grades ? C (a predictor of NCLEX-RN failure) and HESI Exit Exam score (a predictor of passing NCLEX-RN). Grades of C or lower on any course may indicate inadequate mastery of critical NCLEX-RN and increased risk of NCLEX-RN failure.
The number of schools of nursing using remediation to improve student scores on faculty-created and standardized examinations - and ultimately on the NCLEX® - has increased significantly in recent years. This article summarizes key findings in the literature about remediation strategies and approaches used in nursing programs and policies that impact student outcomes. The article also discusses student motivation, methods for measuring the impact of remediation, variables affecting individual student success, suggestions for remediation policy considerations, and future research.
To explore the decision-making process of BSN faculty when determining which best practices to use for classroom testing. A descriptive, correlational study was conducted with a national sample (N = 127) of full-time BSN faculty. Participants completed a web-based survey incorporating instruments that measured beliefs about evaluation, decision-making, and best practices for item analysis and constructing and revising classroom tests. Study participants represented 31 states and were primarily middle-aged white women. In multiple linear regression analyses, faculty beliefs, contextual factors for decision-making, and decision-making processes accounted for statistically significant amounts of the variance in item analysis and test construction and revision. Strong faculty beliefs that rules were important when evaluating students was a significant predictor of increased use of best practices. Results support that understanding faculty beliefs around classroom testing is important in promoting the use of best practices.