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NCLEX-RN Predictor Test Scores
and NCLEX-RN Success
Walden University
Abstract Health care professionals and nurse educators are concerned about increasing percentage of first time test takers failing the NCLEX-RN exam. The purpose of this retrospective study was to examine predictive accuracy of the Assessment Technologies Institute (ATI) RN Comprehensive Predictor for passing or failing the NCLEX-RN exam in a cohort of nursing students ( N = 195). South Eastern Technical College in South Carolina is in jeopardy of losing accreditation for their nursing program because of the low percentage of first time test takers failing. The college’s pass rate on the NCLEX-RN exam has been below the national and state averages for the last 2 years. Guided by Bloom’s taxonomy and Knowles’ andragogical model of learning as the theoretical mainstay, factors that predict success with the NCLEX-RN exam for first time test takers were examined. Inferential and descriptive statistics were used to determine if a relationship existed between NCLEX-RN scores and the independent variables. A Pearson r correlation test was conducted to address whether the ATI Comprehensive Predictor accurately predict student success with the NCLEX-RN exam on first attempt. Multiple regression was employed to test for a significant relationship between prenursing GPA, final GPA, age, gender, and ATI predictor scores. Regression analysis results showed ATI Predictor scores to significantly predict student success with the NCLEX-RN exam on first attempt. Based on these Findings, the Structured Learning Assistance Program was proposed to
assist in preparing students for NCLEX-RN success. Positive social change occurs within the community, nursing programs, and health care by increased NCLEX-RN pass rates enhancing the number of nurses entering into health care.
Dedication Gods’ grace and mercy brought me through this journey along with prayers and encouragement from my family and friends. I would like to dedicate my project study to my late parents, Robert Emanuel and Annie Lee Fore for teaching and showing me that hard work and determination gets results. I see them smiling down from heaven. I would like to thank my husband, Clayton Grant, and my children and grandchildren, Clayton Jarrett, Alicia Nicole, Talayah Zemirah, and America Dava’ for their smiles and encouragement. Lastly, I would like to thank my sister, Bernise Belcer and brother-in- law, Derrick Belcer for their time and patience proofing my work.
Acknowledgements I would like to thank my chairperson, Dr. Janet Reid-Hector for exceptional guidance through this project. I would like to thank my second chair, Dr. Ioan Ionas and my University Research Reviewer, Dr. James Valadez for their guidance in assisting me to achieve this wonderful goal.
List of Tables
Section 1: The Problem Introduction The National Council of the State Board of Nursing (NCSBN) has established three entry levels of practice for registered nurses (RN): associate degree, diploma, and baccalaureate degree. Upon completion of an accredited nursing program, students are required to pass a National Council Licensing Examination (NCLEX), which corroborates competence in performing safe and effective care as a newly licensed nurse. The licensing authorities within each NCSBN govern the NCLEX-RN examination (exam). The NCSBN is responsible for protecting the public by requiring each candidate to pass this exam. According to Rees (2006), many qualified students accepted into nursing schools do not graduate. Attrition in nursing programs is problematic nationwide (Rees, 2006). Traditional nursing students, licensed practical nurses, and paramedic bridge students have difficulty with the course content during the first semester of nursing school (Bonis, Taft, and Wendler, 2007). Students have to adjust to the rigorous nursing curriculum, which includes preparing for clinical and course studies (Rees, 2006). In addition, students are required to take a drug dosage calculation exam and pass with a 90% in order to progress to the next semester (S. McManus, personal communication, June 10, 2013). Nursing graduates must demonstrate competency, critical thinking, problem solving, delegation, and prioritization skills by passing the NCLEX-RN exam (Bonis et al., 2007; Norton et al., 2006). In addition, graduates must demonstrate the minimum knowledge and abilities needed to provide safe and effective nursing care by employing critical
decision-making skills (Norton et al., 2006). An essential component of any nursing program’s success is the pass rate on the NCLEX-RN for first-time test takers. Nursing programs with a history of low passing scores for first-time test takers are at risk for negative impact on their reputations, possibly impacting the school’s enrollment, funding, and accreditation (Rees, 2006). The National League for Nursing Accrediting Commission (NLNAC) and the Commission on Collegiate Nursing Education (CCNE) as well as most state boards of nursing use pass rate data to determine program effectiveness and accreditation (Alameida et al., 2011). Outcome achievement and NCLEX-RN success is a priority for all nurse educators and programs because these benchmarks establish their quality standards and eligibility for accreditation. Nursing programs frequently use NCLEX outcomes to determine content areas that may benefit from curriculum changes and thereby increase student success (Carrick, 2011; Greenspan, Springer, & Ray, 2009). Nursing programs increasingly use such programs as the Assessment Technology Institution (ATI), Health Education Systems (HESI) exit exam, and the Mosby Assessment Test (Mosby). In addition, computerized testing is frequently administered to students during the final semester of the nursing curriculum to provide an assessment of their predicted ability to pass the NCLEX-RN exam on the first attempt. The quality of a nursing education program is defined by the performance of the graduates on the NCLEX-RN examination (Harding, 2010).
are knowledgeable and competent (Roa, Shipman, Hooten, & Carter, 2010). First time test-takers at the college in question failed to maintain the required 89% passing standard for 2 consecutive years. The State Board of Nursing for South Carolina (2011) required the college faculty to develop and present to them an action plan for improving students’ NCLEX-RN scores by May 2012. Rationale Evidence of the Problem at the Local Level The ever-changing NCLEX-RN test plan, question format, passing standard, and combinations of demographic, academic, and psychosocial variables make it difficult to identify academic and nonacademic predictors of NCLEX-RN performance (Gilmore, 2008). Researchers have noted that first-time NCLEX-RN pass rates have steadily declined in recent years (Grossbach & Kuncel, 2011; Truman, 2012). Modifications in question format, test plan, and the increase in standards are contributors to escalating concerns of nursing programs, health care institutions, and the community. Researchers are now tasked with exploring strategies that can increase the NCLEX-RN pass rate (DiBartolo & Seldomridge, 2008). Nursing programs with substandard pass rates have a significant problem. Prospective students use the school’s pass rate as criteria for selecting nursing programs. Application and admission rates are affected if the smarter students do not apply. When at risk students are unsuccessful in completing their program of study, loss of program operating revenue may become a problem. Decreased customer satisfaction is also associated with low performance by the graduates; the school’s perceived reputation
among parents, and the community. The nursing program is at risk for regulatory intervention with program approval and accreditation at stake (Norton et al., 2006). Nursing program administrators are well aware of the decrease in the pass rate for first-time test takers. The nursing shortage has increased the need for nursing students’ success the first time they attempt the NCLEX-RN exam. According to the NCSBN (2010, 2013) patients’ conditions are aggregating in complexity with an increased risk of complications occurring while hospitalized, resulting in the necessity for review of the NCLEX-RN exam every 3 years. With the increased difficulty of the NCLEX-RN exam, nursing programs are being pressured to develop a method of prediction for NCLEX-RN success and to identify students at risk for failing (Norton et al., 2006). A cascade of costly events occurs when a graduate nurse fails the NCLEX-RN exam. The student is devastated and experiences a decrease in self-esteem and confidence, which declines even further during the wait to retake the exam. Graduates have to wait 45 days before retaking the exam, which costs an additional $300 to $ for the second test. The ethical responsibility of graduating students who meet the qualifications and academic rigor of the nursing program but cannot pass the NCLEX-RN exam needs to be addressed by educators (Roa et al., 2010). Table 1 shows that the percentage of successful first time test takers has decreased.
predictors include prenursing GPA, GPA at graduation, science grades, math grades, and predictor test scores. Nonacademic predictors are age and gender (De Lima et al., 2011 London, and Manieri, 2011; Frith, Sewell, & Clark, 2008; Gilmore, 2008; Grossbach & Kuncel, 2011; Horton et al., 2012; Truman, 2012). Evidence of the Problem From the Professional Literature Nurse educators are attempting to improve NCLEX-RN success for first time test takers. Although some students are successful, a number of students continue to fail the NCLEX-RN exam (Gilmore, 2008). Student success or failure can be difficult to identify and is dependent upon associations between variables (Holstein, Zangrilli, & Taboas, 2006). Therefore, nursing programs use standardized testing to assist students prepare for NCLEX-RN. Researchers have attempted to pinpoint what variables influence success or failure in the NCLEX-RN exam (Gilmore, 2008). Researchers have also identified several predictors of success. The academic predictors include high school rank, scholastic aptitude test scores, ACT scores, entering grade point average (GPA), nursing GPA, GPA upon completion of the nursing program, achievement in specific nursing courses, Mosby Assess paper and pencil Tests (Mobsy), and science course grades (Gilmore, 2008). Along with the GPA in nursing courses, the cumulative GPA of general education courses has been cited as a predictor of the NCLEX-RN success (Gilmore, 2008). In addition, higher grades in sciences and nursing courses are also linked to NCLEX-RN success (Gilmore, 2008). A university conducted research on associate’s degree nursing (ADN) students and found that as the scores on the
National Entrance Test (NET), math skills, and reading comprehension improved, the probability of passing the NCLEX-RN increased (Gilmore, 2008). Holstein et al. (2006) conducted a study at a university in North Carolina to identify variables that had the most impact on predicting NCLEX-RN success. These researchers identified 11 variables influential in predicting success or failure in NCLEX-RN takers. With data analyzed at α < .03 and α < .05 levels of significance, among the predictor variables were test scores in several languages, mathematics, and nursing competency measures. The results of the study suggested that the students’ scores on these tests are the most significant measure of success in the NCLEX-RN (Emory, 2013; Holstein et al. 2006). Remediation is one of the strategies proposed to improve NCLEX-RN exam pass rates. In an effort to increase students’ NCLEX-RN success for first time test takers, faculties at a Long Island University School of Nursing in New York examined causes for students’ failure to pass the NCLEX-RN exam on their first attempt (Carr, 2011). Carr (2011) concluded that sources for failure were gaps in curriculum content, student attitudes toward taking the NCLEX-RN exam, delays in taking the NCLEX exam after completing the program, and lack of preparation for standardized testing as well as incongruous and ineffectual exit exams. Faculty implemented strategies to improve student pass rate that included materials designed to close gaps in curriculum content, remediating students with insufficient performance on standardized tests such as the NCLEX-RN predictor exam, and making changes to the exit exam. The NCLEX-RN pass
