Jo Anne Carrick, D. Ed., RN , CNE

Assistant Professor of Nursing

Campus Director – Penn State Shenango

Penn State University

STUDENT ACHIEVEMENT AND NCLEX SUCCESS: PROBLEMS THAT PERSIST

LEARNING OUTCOMES• Challenges of the ever-changing practice environment

• Problems that Persist – Students and Faculty

• What do we know ?

• Predictor indicators - research

• Teaching and Learning System

• Students approach to learning

• Models for Significant Learning

• Intervention Model

• Case Study 1 – Confidence

• Case Study 2 – Individualized plan

• Case Study 3 – Test taking strategies

• Impact Factors

CHALLENGES IN THE CURRENT ENVIRONMENT• Ever expanding curricular content

• Content Heavy….learning light

• Role expansion to include:

• leadership

• continuous quality improvement,

• health care law and reimbursement,

• research and evidence based practice

• ….to err is human – emphasis on safety

• Raising the passing standard

• Raising the first time pass rate requirement for nursing programs

“…if we teach our students nursing the way we learned nursing we are teaching them to practice in a health care environment that no longer exists.”

Judith Halstead, Ph.D. outgoing NLN President

NLN Summit, Washington D.C. 9/2013

PROBLEMS THAT PERSIST - STUDENTS• Academic failure

• Clinical failure

• First time pass rates below expectations

• Changes in the student population

• Adult

• Work to survive

• Multiple life responsibilities

• Varied academic preparation prior to entering nursing

• Identifying students at risk or even when identified…what works!

PROBLEMS WE EXPERIENCE AS FACULTY

• Faculty Experience

• Supportive Presence

• Being involved and available to a struggling student was helpful

• Finding the right level of involvement

• How can we support students without crossing the line between student and teacher?

• Living with our judgments

• Failing a student….maybe she/he could have been a good nurse

• Passing a student…..they will catch up and in reality they do not

• Level of rigor and expectations

Poorman, S. G., Mastorovich, M. L., & Webb, C. A. (2011). HELPING STUDENTS who struggle academically: Finding the right level of involvement and living with our judgments. Nursing Education Perspectives, 32(6), 369-74

WHAT DO WE KNOW?• Student Factors – Predictor indicators

• Nursing GPA

• Age and Motivation – presence of transfer credits

• The most powerful predictor of failure was income at poverty level, followed by science GPA.

• Performance on content mastery tests - Pharmacology

“The most productive application of variables related to NCLEX-RN performance may be in a model that considers a multiple set of predictors. The applicability of any single variable may be questionable, but generally the value is enhanced when aggregated .”

Breckenridge, D. M., Wolf, Z. R., & Roszkowski, M. J. (2012). Risk assessment profile and strategies for success instrument: Determining prelicensure nursing students' risk for academic success. Journal of Nursing Education, 51(3), 160-6. doi:http://dx.doi.org/10.3928/01484834-20120113-03

SYSTEMS DIAGRAMS OF THE NURSING EDUCATION AND THE NURSING STUDENT LEARNING SYSTEM

WHAT DO WE DO TO FIX THE PROBLEMS?

• The Learning Environment

• Curricular change –

• concept based,

• simulation,

• experiential learning

• Assessment testing

• Questions, questions , questions

THEORY FOR SIGNIFICANT LEARNING• Fink’s Taxonomy for Significant Learning

• Foundation knowledge

• Normal values of ABG’s

• Application

• A BG interpretation – respiratory acidosis or alkalosis or compensated

• Integration

• A patient comes into the ED with c/o of SOB. PMH of emphysema. ABG’s are pH 7.45 CO2 56, HCO3 24 Is the patient ok? Would you administer Oxygen? What other data do you want to collect?

• Human Dimension- what does this situation mean to the patient? What aspects of the individual impacts on what you see – i.e. patient is a smoker and despite advise of his physician, hasn’t been able to quit

• Caring – Why should we care about what happens to this patient ? Why is this important?

WHAT DO STUDENTS DO?• The Students Approach to Learning

• Deep – with the intent to understand

• Strategic – with the intent to be organized and get good grades

• Surface – with the intent to memorize and get by

• Best combination – deep and strategic resulted in higher learning outcomes than strategic alone

• High Stakes Testing

• Anxiety - Paralyzed with fear

• Test taking errors

• Cheat

• It’s your fault….not mine

Individualized Plan of Study

Test Taking skillsConfidence

TIME

© Intervention Model for Nursing Students who Struggle Academically

CASE STUDY # 1• Confidence – The story of Jess

• It was December 19th and we were wrapping up the fall semester anxious for the holiday break. Rather than heading home like many of the other students, Jess was waiting outside my office waiting to go over her nursing foundations final. She was talking to my staff assistant telling her that today was her birthday and she was 19. As we started the review she expressed a deep concern about her ability to do well in nursing. She had all “A’s” in her other courses and “C’s” in nursing. With each nursing test her anxiety increased. She maintained a passing grade but by the second year of the program she was overwhelmed with anxiety, confidence shattered, taking medication for anxiety , and testing privately. She made an appointment to see me and as soon as she sat down, the tears started to flow.

CASE STUDY #2• Individualized study plan

• It was Melanie’s second failure of the NCLEX. As she sat in my office I asked her what she thought happened. She stated she studied and practiced questions over and over again. She felt she was prepared even better than the first time.

• I asked…what did Lucy tell you to do? She responded…that didn’t help me…

• Do you really think you know what will help you????

• Analysis of test taking – knowledge, ways they learn and how to sort through material, test taking approach, anxiety

CASE STUDY # 3• Test Taking Errors

• “SOCKS” Analysis

• Stem – Doesn’t read the question carefully enough to determine what is being asked

• Options- Fast Test taker

• Change – changes answers

• Knowledge – really did not have the knowledge to answer the question correctly

• See-sawing – see saws back and forth, knows the right answer but the longer they ponder on the question the more they read into the question and options and select the wrong answer

IMPACT FACTORS• Multifaceted approach

• Teaching environment

• Learning Approach

• Testing quality – KR-20 , question analysis for rigor, multiple formats

• Intervention Model

• Confidence

• Individualized Plan

• Test taking skills – SOCKS analysis

• Time

IMPACT FACTORS• Yesterday is too late

• Incorporate approach from day one

• Examine your baseline and continue to collect your data

• There has to be someone whose primary role is to assess, analyze, and support the development of individualized plans for students

• The Power and Magic of Lucy

• Diagnostic

• Individualized Plan

• Follow up

• Confidence building

REFERENCES• Alameida, Marshall D, PhD,R.N., C.N.S., Prive, Alice,PhD., R.N., Davis, Harvey C, PhD,R.N., C.A.R.N., Landry, Lynette,PhD., R.N.,

Renwanz-Boyle, A., & Dunham, M., PhD. (2011). Predicting NCLEX-RN success in a diverse student population. Journal of Nursing Education, 50(5), 261-267. doi:http://dx.doi.org/10.3928/01484834-20110228-01

• Assessment Technologies Institute. (2012). Understanding the preparation needs of post-graduate and pre-nclex examinees . Stilwell, KS: ATI.

• Barton, L. (2011). The experience of nursing school failure. (Order No. 3497875, Texas Woman's University). ProQuest Dissertations and Theses, , 104. Retrieved from http://search.proquest.com/docview/924437202?accountid=13158. (924437202).

• Breckenridge, D. M., Wolf, Z. R., & Roszkowski, M. J. (2012). Risk assessment profile and strategies for success instrument: Determining prelicensure nursing students' risk for academic success. Journal of Nursing Education, 51(3), 160-6. doi:http://dx.doi.org/10.3928/01484834-20120113-03

• Carrick, J. A. (2011). Student achievement and NCLEX-RN success: Problems that persist. Nursing Education Perspectives, 32(2), 78-83. Retrieved from http://search.proquest.com/docview/863645880?accountid=13158

• Fink, L. Dee (2013) Creating Significant Learning in College Classrooms: An integrated approach to creating college courses. Josey Boss: San Francisco.

• Elliott, M. J. (2011). Academic predictors of national council licensure examination for registered nurses pass rates. (Order No. 3465532, Walden University). ProQuest Dissertations and Theses, , 181. Retrieved from http://search.proquest.com/docview/884081723?accountid=13158. (884081723).

• Emory, D. J. (2012). Use of standardized mastery content assessments given during the first year of a baccalaureate nursing program for predicting NCLEX-RN outcomes. (Order No. 3505834, University of Arkansas). ProQuest Dissertations and Theses, , 118. Retrieved from http://search.proquest.com/docview/1013852297?accountid=13158. (1013852297).

REFERENCES• Lavin, J., & Rosario-Sim, M. (2013). UNDERSTANDING THE NCLEX: HOW TO INCREASE SUCCESS ON THE

REVISED 2013 EXAMINATION. Nursing Education Perspectives, 34(3), 196-8. Retrieved from http://search.proquest.com/docview/1370894354?accountid=13158

• Myrick, K. M. (2013). Applying an educational theory to effectively teach nursing practice and NCLEX categories. Journal of Nursing Education and Practice, 3(3), 124. Retrieved from http://search.proquest.com/docview/1355944413?accountid=13158

• Penprase, Barbara B,PhD., R.N., & Harris, Margaret A,PhD., R.N. (2013). Accelerated second-degree nursing students: Predictors of graduation and NCLEX-RN first-time pass rates. Nurse Educator, 38(1), 26. Retrieved from http://search.proquest.com/docview/1282141071?accountid=13158

• Poorman, S. G., Mastorovich, M. L., & Webb, C. A. (2011). HELPING STUDENTS who struggle academically: Finding the right level of involvement and living with our judgments. Nursing Education Perspectives, 32(6), 369-74. Retrieved from http://search.proquest.com/docview/920892628?accountid=13158

• Romeo, E. M. (2013). The predictive ability of critical thinking, nursing GPA, and SAT scores on first-time NCLEX-RN performance. Nursing Education Perspectives, 34(4), 248-53. Retrieved from http://search.proquest.com/docview/1442705778?accountid=13158

• Simon, E. B., McGinniss, S. P., & Krauss, B. J. (2013). Predictor variables for NCLEX-RN readiness exam performance. Nursing Education Perspectives, 34(1), 18-24. Retrieved from http://search.proquest.com/docview/1324444539?accountid=13158

• Sutton Roberts, D., Ingram, R. R., Flack, S. A., & Jones Hayes, R. (2013). Implementation of mastery learning in nursing education. Journal of Nursing Education, 52(4), 234-7. doi:http://dx.doi.org/10.3928/01484834-20130319-02