Best practices in NCLEX-RN readiness preparation for baccalaureate student success

Success for first-time takers of the NCLEX-RN has implications for the students, faculty, and nursing programs. As the passing standard for the NCLEX-RN has risen, some programs have experienced a corresponding decrease in their graduates' first-time pass rates. This article describes one baccalaureate program's journey from low first-time NCLEX-RN pass rates in 2001 to greater student and program success using a data-based, analytical approach. Although passing an exit exam was a program requirement for 20 years, the change to computerized testing and more in-depth test preparation has enhanced opportunities for success for students and reduced stress.among faculty. The resulting best practices for preparing students for NCLEX-RN success are described.     

Best practices in NCLEX-RN readiness preparation for baccalaureate student success

Success for first-time takers of the NCLEX-RN has implications for the students, faculty, and nursing programs. As the passing standard for the NCLEX-RN has risen, some programs have experienced a corresponding decrease in their graduates' first-time pass rates. This article describes one baccalaureate program's journey from low first-time NCLEX-RN pass rates in 2001 to greater student and program success using a data-based, analytical approach. Although passing an exit exam was a program requirement for 20 years, the change to computerized testing and more in-depth test preparation has enhanced opportunities for success for students and reduced stress among faculty. The resulting best practices for preparing students for NCLEX-RN success are described.     

Predicting Nursing Program Success for Veterans: Examining the Importance of TEAS and Pre-Admit Science GPA

BackgroundSupport for veterans in nursing education programs is a priority in universities across the U.S. While studies have examined the relationship between admission criteria and successful nursing program outcomes, minimal data are available regarding predictors of veteran student success.MethodsSuccess for veterans in one university BSN nursing program was examined, as measured by three outcomes: Nursing program graduation GPA, graduation rate, and NCLEX-RN pass rate, as predicted by two admission criteria: GPA and TEAS.ResultsAmong veteran students, pre-admit science GPAs at or above the median score (3.41) predicted higher nursing program graduation GPA, but did not predict graduation rates or NCLEX-RN pass rates. TEAS scores were not predictive of nursing program graduation GPA, graduation rates or NCLEX-RN pass rates. In comparison, veteran and non-veteran nursing students' graduation rates and NCLEX-RN pass rates were similar; with average nursing program graduation GPAs slightly lower for veterans. Veterans contributed gender, age, and cultural diversity to the nursing student body. When NCLEX-RN exam retakes are included, 100% of all veteran participants were successful, a possible indicator of resilience and work ethic.ConclusionFurther discussion is indicated regarding nursing program admission criteria, and factors for success of veterans in nursing programs.     

Establishing progression policies with the HESI exit examination: a review of the evidence

Schools of nursing across the United States are seeking ways to ensure their pass rates on the National Council Licensure Examination for Registered Nurses (NCLEX-RN) remain above acceptable levels. One way schools of nursing have been seeking to ensure adequate pass rates is by implementing progression policies. These policies prevent students from taking the NCLEX-RN by either preventing student graduation or withholding permission by the school for the student to take the examination. Many of these policies rely heavily, and sometimes solely, on the Health Education Systems, Incorporated (HESI) Exit Examination as a primary predictor of students' NCLEX-RN outcomes. While the HESI Exit Examination can be a useful tool as part of a school's assessment program, it is not able to accurately predict NCLEX-RN failure; therefore, educators are cautioned in using it as the sole predictor of NCLEX-RN outcomes. Schools would be well served by considering more of the evidence available on predictors of student NCLEX-RN outcomes when considering implementation of progression policies.     

Looking at the past to change the future: a retrospective study of associate degree in nursing graduates' National Council Licensure Examination scores

This is a retrospective study comparing academic records and demographic data of students in an associate degree in nursing program who failed the National Council Licensure Examination for Registered Nurses (NCLEX-RN) with students who passed the NCLEX-RN. The sample was obtained from the population of graduates from courses spanning one academic calendar year. The study examined the relationship between multiple variables and success on the NCLEX-RN. The dependent variable was passing NCLEX-RN. Several independent variables include entering cumulative grade point average (GPA), entering nursing curriculum GPA, preadmission examination score, terminal grades in each of the five clinical nursing courses, National League for Nursing examination scores taken in various program courses, graduating GPA, and Health Education Systems, Inc. (HESI), examination score taken at the end of the program. Standardized test results and the pass/fail rate in the nursing courses taught in the curriculum appear to be the most significant variables identified in profiling the student most likely to fail NCLEX-RN. Males and minorities (Black, Hispanic, and Asian) had a lower pass rate than their White counterparts.     

Strategies for success: crisis management model for remediation of at-risk students

Student success is a concern for all nursing schools. Accountability for NCLEX(?) pass rates, along with accountability for student attrition and progression, compel nursing schools to carefully select applicants and then actively manage their progress. One of the strategies of managing student progression is to use standardized, nationally normalized exit examinations to identify students at risk for NCLEX-RN failure. This article describes the response of one baccalaureate nursing program to an unacceptable number of exit examination failures among senior students preparing to graduate. As a unique approach to this matter, a crisis management process was used to assess the problem, to develop and implement an intervention for at-risk students, and to revise program policies to better support ongoing student success.     

NCLEX-RN preparation: enabling candidates to pass

Today's NCLEX-RN candidates are potentially the RNs of tomorrow. It has become increasingly important and cost effective for hospitals to work with their NCLEX-RN candidates to enable them to pass the licensure exam the first time it is taken. Preparation of candidates may include review courses, review books, group work, and individual review materials. Building on the solid educational foundation each nurse brings to the hospital, the nurse educator can develop cost effective strategies to help their candidates pass the NCLEX-RN.     

The use of “high‐stakes testing” in nursing education: Rhetoric or rigor?

The expectations for clinically ready graduates have increased over the years, paralleling changes in the NCLEX exam with increasingly cognitively difficult items in preparation for professional nursing practice. Yet, it is widely recognized that nursing program exit standardized exams have come under increased scrutiny in several public cases. Several articles have frequently been cited in the opposing argument against use of the HESI Exit Exam or other standardized nursing exit exams. We review two of these for logical coherence and standard psychometric adherence given their recurrent use in arguing against nursing program exit standardized testing. In light of patient safety implications and school accreditation consequences, it's more important that schools use exit standardized testing and assess minimum competency of students based on an exit program standardized exam. Measurement standards are critical to these analyses. The use of a program exit standardized exam also alerts students that faculty are holding them accountable for their time in the program.     

Predicting Success for Associate Degree Nursing Students in a Concept-Based Curriculum

The study objective was to assess critical thinking scores, National Council Licensure Examination for Registered Nurses (NCLEX-RN) prediction scores, and NCLEX-RN pass rates for associate degree nursing (ADN) students educated with a concept-based curriculum. Results suggested that a concept-based curriculum can assist in developing critical thinking among ADN students, and critical thinking and probability of pass scores may be used as predictors for first-time NCLEX-RN passage for ADN students in a concept-based curriculum.     

Standardized testing in nursing education: Preparing students for NCLEX-RN® and practice

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.     

Continuous quality improvement: an effective strategy for improvement of program outcomes in a higher education setting

The nursing department at a historically black university has implemented a continuous quality improvement approach to improve its program outcomes. A quality enhancement plan was designed with three major goals: to increase NCLEX-RN pass rates, to improve student advisement processes, and to increase student satisfaction. The strategies implemented to meet these outcomes are described and evaluated.     

Evidence-based strategies for standardized exam remediation in nursing: An integrative review

Many nursing programs use standardized exams to prepare students for the National Council Licensure Examination (NCLEX). Often, students are encouraged or required to remediate based on results. The value and common use of remediation in nursing education is well documented. However, evidence is less clear regarding remediation best practices. The purpose of this integrative review of literature was to identify evidence-based standardized exam remediation strategies and policies that help students achieve higher standardized exam scores and pass the NCLEX. Five computerized databases were systematically searched for primary research and quality improvement studies that examined remediation strategies following the administration of standardized nursing exams. Results were screened using a three-phase process, leading to a final sample of 24 articles. Three remediation strategy themes were identified: self-guided activities and assignments; faculty-guided group activities; and faculty-guided individual activities. Four remediation policy categories were revealed: required remediation if benchmark score is not met; required retesting if benchmark score is not met; delay in progression if benchmark score is not met; and credit awarded for completing remediation. These findings provide guidance for nursing programs seeking to develop or refine remediation policies and practices to better support students’ learning and increase NCLEX pass rates.     

Implementing a Standardized Testing Program: Preparing Students for the NCLEX-RN

The undergraduate nursing faculty of a large Midwestern university initiated a program of standardized computerized testing for two purposes: to provide students experience with standardized computerized testing prior to taking the National Council Licensure Exam for Registered Nurses (NCLEX-RN) and to increase the students' NCLEX-RN passing rate. This article chronicles the process of implementing a comprehensive testing program developed by the Assessment Technologies Institute (Overland Park, KS). Although the first class of students to have taken the entire testing package has just graduated, midprogram results have demonstrated potential as key indicators for identifying at-risk students. The trends in scores on standardized computerized tests, grades in prerequisite science courses, and grades in medical-surgical courses are used to identify students who are at risk for failure in the program and on the NCLEX-RN. Faculty advisors meet with these students to develop individual plans of study and to provide additional resources. The testing process is going on smoothly, and faculty members are learning to use the extensive information on students' test scores to further assist them in passing the NCLEX-RN.     

Remediation for NCLEX-RN success in high-risk nursing students

Background: The National Council Licensure Exam (NCLEX-RN) pass rate is often used as a measurement to determine a successful undergraduate nursing program. Students that are not successful in the first attempt of taking this exam are statistically unlikely to pass on the second attempt.Purpose: To determine if the implementation of a prescribed remediation protocol would improve undergraduate baccalaureate predictor scores for passing the NCLEX-RN exam on the first attempt for high-risk students.Methods: A retrospective cohort study design was used to compare scores of nursing students after a prescribed remediation protocol was instituted.Results: A one-way ANOVA test was conducted to compare the effect of a remediation policy on nursing students enrolled in an undergraduate nursing program. Remediation had a significant effect at the p < 0.05 level for six cohorts consisting of F (5,232) = 9.90 and a p value of 0.0000000133. Post hoc comparisons using the Tukey HSD test indicated that the comprehensive predictor exam mean score for those that received remediation was significantly different than those that did not receive remediation in like cohorts.Conclusion: A prescribed remediation protocol assisted students in achieving the necessary scores on the Comprehensive Predictor exam to increase their likelihood of success on NCLEX.     

Bilingual nurse education program: applicant characteristics that predict success

Nurses are in great demand across the United States, but those fluent in both Spanish and English are in particularly short supply. This study examined three cohorts of students that entered a Spanish-English nursing education program to determine characteristics of applicants that produced student success. Unlike many nursing programs, entrance requirements for this bilingual program did not include a minimal grade point average (GPA) or previous course completions. Logistic regression was used to analyze the relationship between five different characteristics of entering students and their later success in the program. Success was measured in terms of program persistence and performance on the NCLEX-PN and NCLEX-RN exams. Incoming students with relatively high GPAs (M = 3.2) were significantly more likely to persist through the entire nursing 0ronram and oass the NCLEX-RN exam (t < .05) than those with lower GPAs (M = 2.5).     

Student achievement and NCLEX-RN success: Problems that persist

While most nurse graduates are successful on the NCLEX-RN licensure examination, certain students continue to be at risk for failure. To understand the complexity of at-risk students and NCLEX-RN failure, systems theory was used to analyze the interdependency of the nursing education system and the nursing student learning system. From this perspective, these problems relate to flaws in perceived learning gaps and student outcome measures. Predicting NCLEX-RN success is further complicated because students leave the teaching system prior to taking the exam, making them vulnerable to other influencing variables. The student's approach to learning (SAL) theory was used to aid in identifying effective strategies. The literature supports this theoretical approach, which targets changing the teaching and learning environment. However, there is limited research on the nursing student's approach to learning, on the benefits of innovative student-centered learning environments, and the most effective use of NCLEX-RN assessment products.     

Retaining Graduate Nurses Who Experience NCLEX Failure: Recommendations for Supporting Retest Success

Current turbulent times in health care are exacerbated by a shortage of registered nurses (RNs), challenging nurse leaders to explore opportunities for improving RN retention. National Council Licensure Examination (NCLEX) pass rates are declining, and an upcoming change in the NCLEX-RN exam is likely to intensify that decline. On average, 18% of graduate nurses (GNs) fail on their first NCLEX-RN attempt, and less than 43% are successful on retest attempts. Therefore, the GN who fails on the first attempt is likely to not be retained for the RN position for which they were hired. A consideration in supporting the GN who fails to retest success is that the most prevalent demographic among GNs is Generation Z. Individuals in this generation display characteristics that impact their ability to negotiate the high-stakes NCLEX-RN exam. Based on experience coaching Generation Z GNs to NCLEX-RN success, the author provides recommendations for coaching to support NCLEX retest success. Nurse leaders in hospital settings are encouraged to consider adopting these recommendations to improve RN retention among GNs who experience NCLEX failure.