Social processes influencing nursing students in passing the nursing licensure examination: A grounded theory approach

AIM

To explore the strategies used by nursing students in passing the nursing licensure examination.

DESIGN

This study uses a classic grounded theory design to explore the social processes influencing a nursing license examination.

METHODS

Eight graduate students participated in this research study and were interviewed in-depth twice. The Classic Grounded Theory method of Glaser was applied to collect and analyse the data until saturation was reached.

RESULTS

The findings revealed that students who passed the nursing licensure examination described the strategies as a preliminary model comprising a core category, Reviewing (Phase 1), which consisted of two sub-categories: Entering Time and Reviewing Styles. Additionally, two other main categories emerged: the Tutoring category (Phase 2) and the Testing Practice category (Phase 3). It was observed that each course (subject) does not necessarily follow a specific order in traversing these phases; they may move back and forth between them until the conclusion of the examination. Furthermore, it was found that the time allocated to Entering Time and completing the three phases significantly influences the successful passing of the nursing licensure examination.

Evolving Licensure Examination: Assessing Student Confidence and Accuracy With Next Generation NCLEX

BACKGROUND

The Next Generation NCLEX (NGN) includes new item types. Little is known about nursing students' confidence and accuracy in answering these questions.

METHOD

A descriptive comparative study examined prelicensure nursing students' confidence and accuracy in answering NGN-style items versus multiple-choice questions (MCQs) of the same content via a 12-item quiz.

RESULTS

Less than one third of students (n = 194; 32.1%) reported feeling confident in answering NGN questions. Students' confidence levels had no relationship on scores with NGN items. When comparing NGN-style items to MCQs, students' (n = 221) scores on NGN-style items were lower with bowtie or a select-all-that-apply questions but higher with highlight table or matrix multiple-choice questions.

CONCLUSION

Students' lack of confidence with certain item types suggests faculty should incorporate these item types into classroom activities or course assignments. NGN test-taking strategies also should be incorporated and frequently reinforced throughout the curriculum. [J Nurs Educ. 2024;63(4):252-255.].

An Overview of Nursing Regulation

The rules and regulations that govern nursing practice are topics rarely covered in nursing education programs. This article aims to provide a basic understanding of state and federal rules that govern nursing practice; the role and duties of nurse regulatory boards; types of legal actions that nurses may face; and an overview of discipline, complaint, and reporting processes.

Faculty Development on the Use of a Clinical Judgment Model in the Pre-licensure Nursing Curriculum

Clinical judgment is an essential component of safe nursing practice that pre-licensure nursing students should develop by graduation from accredited nursing programs. For novice nurses, the consequences of underdeveloped clinical judgment skills that do not meet the demands of clinical practice are serious. This theory-practice gap correlates with increased numbers of errors occurring during care delivery, resulting in poorer patient outcomes. From a student perspective, this problem correlates with lower first-time pass rates on the NCLEX licensing exam. For nurse educators, there are uncertainties about how to resolve this complex and costly problem, but faculty development is one evidence-based solution to explore. The purpose of this article is to describe a three-pronged quality improvement project consisting of: 1) a faculty development session to teach faculty to implement the National Council State Boards of Nursing's Clinical Judgment Model (CJM) in their courses; 2) the use of the Clinical Judgment Tool; and 3) the implementation of a faculty champion to sustain and maintain ongoing faculty momentum to foster clinical judgment. This article focuses on how faculty can develop their own CJM faculty development session and use a CJM across the course curriculum.

Preparing Nurse Educator Students for the New National Council of State Boards of Nursing NCLEX and AACN Essentials

BACKGROUND

Graduate nursing education students are required to complete essential core content (such as education theory, accreditation, evidence-based teaching strategies, and evaluation methods) to prepare them to transition into independent practice. The 2021-2022 academic year required a monumental change in the existing curriculum to incorporate the 2021 American Association of Colleges of Nursing Essentials and the Next Gen National Council Licensure Examination (NCLEX) content.

METHOD

An innovative, prioritized, learner-centered, backward design was used to update the existing curriculum to add the new core content to the nursing education student curriculum.

RESULTS

The end of program comprehensive exams revealed that the students were able to successfully develop a test blueprint, utilizing case studies with Next Gen NCLEX question types designed to measure clinical judgment, and map to the 2021 AACN Essentials.

CONCLUSION

The timely implementation of the curriculum revisions resulted in the achievement of desired student learning outcomes. [J Nurs Educ. 2024;63(3):192-196.].

An NCLEX-RN Improvement Project: A Study of Student Attributes Associated With Test Success

BACKGROUND

A school of nursing developed a process to improve graduates' NCLEX-RN scores through a committee tasked with identifying approaches to assist students in passing the NCLEX-RN on the first attempt.

METHOD

The process involved: (1) engaging the faculty to use current published evidence; and (2) conducting an anonymous survey of previous graduates to identify the factors associated with NCLEX-RN success in the school's student population. Logistic regression analysis was conducted on a sample of 165 graduates of the program.

RESULTS

The analysis of the graduates' psychosocial, academic, and NCLEX-RN preparation attributes compared with NCLEX-RN outcome revealed grade point average was the strongest significant predictor of success.

CONCLUSION

The NCLEX-RN success program served to engage the school of nursing faculty. In addition, a study of the program's graduates revealed a predictor of potential student success that can identify students who may need additional support early in the program. [J Nurs Educ. 2024;63(2):102-107.].

The effectiveness of badging systems in engaging, motivating, and incentivizing students in the mastery of nursing licensure materials

INTRODUCTION

Integrating gamification methods into undergraduate nursing programs has prepared students to pass the nursing comprehensive predictor test and the licensure examination.

LITERATURE REVIEW

Research demonstrates that the motivational factors of game elements like badging and leaderboards are of great value and utility to student engagement and motivation. The badges symbolize achievement, authority, and belonging, whereas leaderboards rank students based on different levels of course engagement.

DISCUSSION

This paper explores the benefits, challenges, and strategies of incorporating digital badges and leaderboards in the undergraduate program. Immersion courses preparing students for professional practice are usually one of the last didactic courses offered in the undergraduate curriculum, designed to integrate all knowledge gained from the nursing program.

IMPLICATIONS FOR AN INTERNATIONAL AUDIENCE

The digital badging system can encourage nurse educators globally to engage, motivate, and power students to achieve professional goals. Furthermore, nursing programs worldwide can benefit from adding digital badges and leaderboards to final semester preparatory courses or any nursing course with the same emphasis.

CONCLUSIONS

Digital badges and leaderboards engage and motivate students to integrate knowledge and skills learned in the nursing program and successfully master nurse licensure materials.

Comparative Analysis of NCLEX-RN Questions: A Duel Between ChatGPT and Human Expertise

BACKGROUND

Artificial intelligence (AI) has the potential to revolutionize nursing education. This study compared NCLEX-RN questions generated by AI and those created by nurse educators.

METHOD

Faculty of accredited baccalaureate programs were invited to participate. Likert-scale items for grammar and clarity of the item stem and distractors were compared using Mann-Whitney U, and yes/no questions about clinical relevance and complex terminology were analyzed using chi-square. A one-sample binomial test with confidence intervals evaluated participants' question preference (AI-generated or educator-written). Qualitative responses identified themes across faculty.

RESULTS

Item clarity, grammar, and difficulty were similar for AI and educator-created questions. Clinical relevance and use of complex terminology was similar for all question pairs. Of the four sets with preference for one item, three were generated by AI.

CONCLUSION

AI can assist faculty with item generation to prepare nursing students for the NCLEX-RN examination. Faculty expertise is necessary to refine questions written using both methods. [J Nurs Educ. 2023;62(12):679-687.].

Effects of the COVID-19 Pandemic on Comprehensive Predictor Scores as Proxy for the NCLEX-RN

BACKGROUND

Research is needed to examine whether the coronavirus disease 2019 (COVID-19) pandemic affected nursing students' NCLEX-RN pass rate. A decline in the NCLEX-RN pass rate would be detrimental to the nursing workforce, the nursing shortage, and nursing educational programs. This quantitative comparative study analyzed the effect of the COVID-19 pandemic on nursing students' Comprehensive Predictor scores as a proxy for the NCLEX-RN.

METHOD

An independent t test was conducted to test for a difference in Comprehensive Predictor scores of nursing students before and during the COVID-19 pandemic.

RESULTS

There was no statistically significant difference in Comprehensive Predictor scores before and during the pandemic.

CONCLUSION

Because there was no significant change in nursing students' pass rate on the Comprehensive Predictor as a proxy for the NCLEX-RN during the COVID-19 pandemic, the number of new graduate nurses entering clinical practice is expected to remain the same as pre-pandemic levels. [J Nurs Educ. 2023;62(11):638-641.].

An audit of mental health questions on U.S. nursing licensure applications: Evidence to guide urgent action for change

BACKGROUND

Nurses often forgo needed mental healthcare due to stigma and fear of losing their license. The decision to access care or disclose mental health struggles is intensified when registered nurses (RNs) or advanced practice registered nurses (APRNs) discover that licensure applications ask invasive mental health questions that could impact their ability to work.

AIMS

This study highlights findings from an audit of mental health and substance use questions included in RN and APRN licensure applications across the United States.

METHODS

A sequential 4-step approach was used to retrieve RN and APRN licensure applications: (1) review of Board of Nursing (BON) websites, (2) communication with BON staff, (3) communication with Deans of Nursing to ask for retrieval assistance, and (4) creation of mock applicants. An embedded checklist within the Dr. Lorna Breen Heroes Foundation's Remove Intrusive Mental Health Questions from Licensure and Credentialing Applications Toolkit guided the audit. Two study team members reviewed the applications independently for intrusive mental health questions, which were designated as non-compliant with the Toolkit's recommendations and arbitrated for consensus. States were designated as non-compliant if ≥1 item on the checklist was violated.

RESULTS

At least one RN and APRN application was obtained from 42 states. Only RN applications were obtained from five states, while only APRN applications were obtained from three states. Only 13 states (26%) fully adhered to the Took-Kit checklist.

LINKING EVIDENCE TO ACTION

The majority of BONs did not fully adhere to the Took-Kit checklist. Guidance from national organizations and legislation from state governments concerning the removal or revision of probing mental health and substance use questions is urgently needed to cultivate a stigma-reducing environment where nurses are supported in seeking needed mental health treatment.

Course repetition in pre-licensure nursing students: A scoping review

SIGNIFICANCE OF PROBLEM

Nursing student attrition is a global issue affecting students, nursing programs, and the profession. One group of nursing students at risk for attrition are those that have failed and need to repeat a required nursing course. These students experience academic consequences such as delayed graduation and entry into the workforce, further contributing to the nursing shortage. Unfortunately, current literature about nursing student repeaters remains inadequate, and evidence of support measures is minimal.

PURPOSE

This scoping review aims to summarize the literature on course repetition in pre-licensure nursing students and identify gaps in the literature about this population.

METHODS

Arskey and O'Malley's (2005) five-step procedure was used as the organizing framework to explore course repetition in pre-licensure nursing students.

RESULTS

There were twenty articles relevant for this scoping review. The findings revealed nursing student repeaters are at an increased risk for subsequent failure and attrition. Students experienced shock, sadness, and uncertainty when course failure ensued. Nursing students sought additional help while repeating failed courses, but interventions solely harnessed toward student repeaters can be beneficial.

CONCLUSION

Nursing student repeaters are a unique population that requires a multifaceted approach, including academic and non-academic support structures, to ensure they meet the educational standards of the repeated course. Future studies regarding this population should include progression policies' impact on student success and strategies and interventions that create positive outcomes among student repeaters.

Strategies to Increase NCLEX Pass Rates: From 68% to 92% in 1 Year

BACKGROUND

One of the key indicators of a quality prelicensure nursing program is the NCLEX first-time pass rate. NCLEX-RN pass rates have been decreasing over the last several years.

PROBLEM

The decrease in NCLEX pass rates suggests that nursing programs analyze their curriculum with the goal of increasing NCLEX scores.

APPROACH

One small associate degree in nursing program implemented strategic changes to positively improve NCLEX success, which included curriculum revisions and incorporating a clinical judgment framework.

OUTCOMES

By using several innovative strategies, this program increased its first-time NCLEX pass rates by 24%.

CONCLUSIONS

The purpose of this article is to provide strategies that significantly increased the NCLEX-RN pass rates within 1 year. With the Next Generation NCLEX's launch in April 2023, nursing programs must be proactive in identifying strategies to prepare students for the NCLEX.

Academic Differences in BSN Admission Routes: Implications for Persistence

BACKGROUND

To increase retention of prelicensure nursing students, several routes are used for admission to nursing programs. Students can be accepted as an early matriculation (EM) student at the point of university admission or they can follow a traditional competitive approach (TR) for admission.

METHOD

A retrospective matched cohort study design was used to explore the differences among selected academic variables in two groups of prelicensure undergraduate students (n = 136) in the same program.

RESULTS

EM students had significantly lower science grade point averages (GPAs), pre-program GPAs, and junior-level GPAs than TR students. However, there were no significant differences between the two groups in scores on the RN Fundamentals ATI examination, an important predictor of future NCLEX-RN success.

CONCLUSION

EM students were as successful as their counterparts on standardized examinations in the first semester of a nursing program. More research is needed to understand program outcomes associated with students entering nursing programs via different routes. [J Nurs Educ. 2023;62(5):302-306.].

Teaching Social Determinants of Health Through an Unfolding Case Study

BACKGROUND

The impact of social determinants of health (SDOH) was developed to educate nursing students through the use of an unfolding case study.

PROBLEM

SDOH and population health are critical components of prelicensure nursing education. Unfolding case studies are a strategy to develop critical thinking and teach SDOH to nursing students.

APPROACH

A model was used to develop the case study including a community assessment, which follows a male veteran and family through life events. Implementation of the unfolding case study took place over 3 consecutive semesters in a community health nursing course.

OUTCOMES

This educational activity achieved standardized examination scores, which are intended to assess student preparedness for the National Council Licensure Examination (NCLEX), above the national averages. Student participation was above 90%.

CONCLUSION

Unfolding case studies can present realistic scenarios that are useful to teach critical thinking. As the Next Generation NCLEX moves to scenario-based testing, unfolding case studies are a teaching strategy to prepare students.

NCLEX Pass Rates Drop Again

Remote learning forced by the COVID-19 pandemic may have been a factor.

Supporting student success on the practical nurse (PN) licensure exam: The Health Education Systems Incorporated (HESI) PN Exit Exam Study

BACKGROUND

Practical Nurses or Vocational Nurses (PNs/VNs) complete a 12-month certificate program and must successfully complete the National Council Licensure Exam for Practical Nurses (NCLEX-PN) prior to practice. While the scope of their practice is more circumscribed than the Registered Nurse (RN), they contribute significantly to healthcare throughout the U.S.A. Current research to support their learning and success is needed. Elsevier's Health Education Systems Incorporated (HESI) PN Exit Exam (E2) has been used to determine students' NCLEX-PN readiness for over 20 years. Given regular updates to the NCLEX test plan, ongoing research is needed to assess the E2's continued predictive validity and examine E2 program policies to enhance PN/VN student success.

OBJECTIVES

To examine the predictive validity of the E2 on NCLEX-PN first-time pass rates (NCLEX-PN FTPR) and determine which E2-related program policies are related to higher E2 scores and NCLEX-PN FTPR.

METHOD

Sixteen PN/VN program directors participated in the study, providing E2 program policy information and NCLEX-FTPR outcomes for 1371 students who took the E2 between 2018 and 2021.

RESULTS

Students passed the NCLEX-PN 96-98 % of the time when they scored 900 or higher on the E2 and passed 94 %-96 % of the time when they scored 850 or higher. Out of 16 programs, most required E2 test preparation (n = 13, 81.25 %) and allowed students more than one E2 attempt (n = 11; 68.75 %). Requiring minimum E2 scores and specific E2 test preparation were associated with higher NCLEX-PN pass rates, in each case mediated by higher E2 scores. Requiring remediation for students with low initial E2 scores led to higher E2 scores but not higher NCLEX-PN pass rates.

CONCLUSIONS

This study provides evidence for program policies and educational resources to support students' NCLEX-PN success. Setting an expected performance benchmark and requiring PN students to engage in E2 preparation prior to their first attempt are recommended strategies emerging from this study.

Gender Role Conflict and Male Nursing Students' Academic and Program Success

BACKGROUND

Despite calls to increase the proportion of men in nursing, little change has occurred, and anecdotal accounts suggest poor retention of men in nursing programs. This study explored the role that gender role conflict (GRC) may play in men's academic success.

METHOD

Men in a large nursing program (n = 123) in the United States were surveyed to explore their GRC upon entry to their nursing program and then again 1 and 2 years later. GRC results, academic test scores, and indicators of program success were analyzed to explore GRC patterns over time and the influence of GRC on academic and program outcomes.

RESULTS

GRC did not significantly influence most measures of academic success, program completion, or NCLEX-RN results.

CONCLUSION

GRC does not appear to influence academic or program success; however, additional research is needed. [J Nurs Educ. 2023;62(1):42-46.].

Pedagogical strategies of LGBTQIA+ education in pre-licensure nursing: An integrative review

OBJECTIVES

Previous research suggests that information about providing culturally sensitive care to patients of the LGBTQIA+ population has been lacking among pre-licensure nursing programs. This is due, in part, to a lack of faculty preparation and knowledge regarding LGBTQIA+ issues. The purpose of this integrative review is to examine pedagogical strategies of LGBTQIA+ content integration in pre-licensure nursing programs in the United States.

DATA SOURCES

The literature search was conducted by searching CINAHL, the Cochrane Database, PubMed, MEDLINE, Google Scholar, and PsychINFO for peer-reviewed articles that were written in the English language and completed in an educational setting.

REVIEW METHODS

The search was conducted by a single independent reviewer. Inclusion and exclusion criteria were applied to articles identified by the databases. Eighteen articles met all identified criteria. Articles were appraised using resources from the Joanna Briggs Institute and one article was excluded from further consideration after appraisal. Seventeen articles were analyzed for themes.

RESULTS

Three themes emerged from the review: lecture and dialogue, experiential learning, and reading and writing.

CONCLUSIONS

Based on the review of the literature, there is a myriad of evidence-based pedagogies to incorporate LGBTQIA+ content into pre-licensure nursing programs. Students were successful in achieving learning outcomes and interventions were well-received. The studies in this review may assist in mitigating a lack of faculty preparedness in teaching LGBTQIA+ content by providing examples of pedagogical strategies that can be adapted to fit their particular course or program.

Learning Impact of Armed Forces Medical Background on Military Nursing Students in an Accelerated Bachelor of Science in Nursing Program

The study examined differences between military students enrolled in an accelerated bachelor of science in nursing (BSN) program with and without medical experience and/or a previous bachelor's degree on graduation grade point average (GPA) and NCLEX®-RN first-time pass rates. Significant differences were found between groups with/without military medical experience on NCLEX-RN, but not graduation GPA. Significant differences were found between groups with/without prior degree on GPA, but not on NCLEX-RN. Having both medical experience and a prior degree did not make a difference on GPA or NCLEX-RN. Findings offer guidance on admission criteria to accelerated programs for this unique group of students.

Development of examination objectives based on nursing competency for the Korean Nursing Licensing Examination: a validity study

PURPOSE

This study aimed to develop the examination objectives based on nursing competency of the Korean Nursing Licensing Examination.

METHODS

This is a validity study to develop the examination objectives based on nursing competency. Data were collected in December 2021. We reviewed the literature related to changing nurse roles and on the learning objectives for the Korea Medical Licensing Examination and other health personnel licensing examinations. Thereafter, we created a draft of the nursing problems list for examination objectives based on the literature review, and the content validity was evaluated by experts. A final draft of the examination objectives is presented and discussed.

RESULTS

A total of 4 domains, 12 classes, and 85 nursing problems for the Korean Nursing Licensing Examination were developed. They included the essentials of objectives, related factors, evaluation goals, related activity statements, related clients, related settings, and specific outcomes.

CONCLUSION

This study developed a draft of the examination objectives based on clinical competency that were related to the clinical situations of nurses and comprised appropriate test items for the licensing examination. Above results may be able to provide fundamental data for item development that reflects future nursing practices.

Variation in State Education Regulations for RNs

BACKGROUND

There is variation in nursing education quality, measured as first-time NCLEX (National Council Licensure Examination)-RN pass rates (FTPR), both across and within the United States. Current research examines program-level characteristics associated with performance.

METHOD

This study examines state-level policies and their relationship to FTPR (both associate and baccalaureate nursing degrees) to identify policies that enhance nursing program quality. Ordinary least squares regression analyses were conducted for state and program levels, and tests for interactions of variables were conducted between the two levels.

RESULTS

Accredited for-profit programs were associated with a 24% higher FTPR than nonaccredited for-profit programs. In addition, for-profit programs in more business-friendly states were associated with an 11.8% lower FTPR.

CONCLUSION

National standards for licensure pass rates, a mandate that all programs be accredited, and better enforcement could help improve the quality of RN programs nationwide. States with pro-business policies should be aware of the effect of their policies on the proliferation of for-profit schools. [J Nurs Educ. 2022;61(5):242-249.].

Breaking Down Institutional Barriers to Advanced Practice Registered Nurse Practice

Advanced practice registered nurses (APRNs) significantly contribute to health promotion, disease prevention, and disease management. Yet, barriers to APRN practice exist, including regulatory, state, and institutional barriers, that hinder their ability to practice to the full extent of their education, licensure, and certification. Nurse leaders can play an important role in helping reduce unnecessary institutional barriers to APRN practice.

Preparedness to Write Items for Nursing Education Examinations: A National Survey of Nurse Educators

BACKGROUND

Nursing programs in the United States primarily use multiple-choice questions to prepare students for the NCLEX.

BACKGROUND

Nursing programs in the United States primarily use multiple-choice questions to prepare students for the NCLEX. Currently, the optional next-generation NCLEX is testing the validity and reliability of situational case studies.

PURPOSE

The purpose of this study was to investigate the preparedness and confidence of nurse educators in writing NCLEX-style questions.

METHODS

A descriptive survey design with snowball sampling was used to collect the data and was sent to 1550 deans/directors/coordinators of publicly available email addresses of accredited schools of nursing.

RESULTS

A total of 300 participants completed the survey from 44 states. When asked about confidence in writing NCLEX-style items, those who received formal education or training reported being somewhat confident (51%), whereas those who did not reported ambivalent or not confident (49%).

CONCLUSION

Surveyed nurse educators lack confidence in writing questions and feel unprepared for the new question types instituted by the NCSBN in 2023. Nurse educators need continued education to develop and review NCLEX-style items and examinations.

Outcomes of Remediation Strategies Implemented by the Illinois Board of Nursing to Improve Program NCLEX Pass Rates: A Five-Year Follow-Up

After noting a marked decline in National Council Licensure Examination (NCLEX) pass rates for Illinois programs, the Illinois Board of Nursing created its remediation strategies tool based on standards of two accrediting bodies for use by programs with NCLEX pass rates of less than the state-mandated 75 percent. Five-year follow-up data demonstrated a marked decrease in number and percentage of programs with unsatisfactory results, which were consistent over time. Qualitative survey data across Illinois programs further supported the tool as a valuable resource.

Academic Factors Predicting NCLEX-RN Success

This retrospective study examined the relationships among 10 academic predictors and first-time success on the NCLEX-RN in a sample of 92 bachelor of science in nursing minority and culturally diverse generic/traditional students at a large minority-serving, urban, public university. Predictors included the Test of Essential Academic Skills (overall, science, and reading), science grade point average (GPA), cumulative GPA, and scores on various standardized exams: Kaplan, HESI, and ATI. Discriminant analysis found science GPA of >3.50 and ATI B of 60 or above to be the best predictors of passing NCLEX-RN. Based on statistically significant differences between NCLEX-RN pass and fail scores, good indicators of NCLEX-RN success were scores of 50 or above on Kaplan and 950 or above on HESI. Overall, the Test of Essential Academic Skills did not predict students' NCLEX-RN outcomes.

A Model for Student Success

BACKGROUND

Institutions may be experiencing an increasing number of applicants who are underprepared for nursing study, especially institutions with access missions. Early identification and intervention can mitigate risk of attrition and unsuccessful NCLEX-RN^® outcomes.

METHOD

An initial study of approximately 1,500 graduates from a multi-campus system led to the development of a comprehensive approach to student success. The model includes identifying nonacademic success factors through an early assessment survey, implementing a data-driven admissions matrix, changing progression policies, designing a new learning-relearning approach, and offering robust cocurricular student support.

RESULTS

NCLEX-RN pass rates and student persistence have improved in the 4 years since implementation, and graduation rates are stable.

CONCLUSION

Although improvements have been made, there is more work to do. African American students have not demonstrated overall improvements when compared to students of different racial and ethnic backgrounds. Further research is needed to test, design, and implement strategies to address social and race-related factors influencing persistence and success. [J Nurs Educ. 2022;61(2):101-104.].

Pre-licensure nursing students' experiences of psychological safety: A qualitative descriptive study

BACKGROUND

Organizational learning is essential for consistently providing safe, efficient, high-quality patient care. Psychological safety is foundational for organizational learning. For pre-licensure nursing students psychological safety is crucial for both their learning and patient safety. Understanding pre-licensure nursing students' experiences of psychological safety can guide efforts to cultivate clinical environments conducive to learning and excellent patient care.

OBJECTIVES

The objective of this study was to gain insight into pre-licensure nursing students' first-hand experiences with psychological safety in clinical settings.

DESIGN

A qualitative, descriptive design was used for this study.

SETTINGS

Participants were recruited from 12 different nursing programs across eight states.

PARTICIPANTS

A total of 26 pre-licensure nursing students participated in this study. Included were students who had completed at least one clinical rotation, but had not yet obtained licensure as a registered nurse.

METHOD

Semi-structured interviews were conducted via telephone. Interviews were analyzed using a constant comparative approach to thematic analysis.

RESULTS

Four primary themes emerged from the data, two of which had sub-themes: 1) Feeling Self-Conscious, with the sub-themes Expecting Expectations and Interpreting Feedback; 2) Engaging; 3) Learning and Performing; and 4) Moving Forward, with the sub-themes Using Coping Strategies and Developing Confidence.

CONCLUSIONS

This study reinforces the importance of psychological safety for nursing students' learning and for patient safety. Feeling psychologically safe allowed students to engage in the clinical setting, to learn from their experiences, and to perform their very best. With these insights, faculty and clinical preceptors can cultivate effective learning environments where patients can also receive safe, high-quality patient care.

Academic dismissal from a baccalaureate nursing program: The student's perspective

BACKGROUND

The dismissal of a nursing student is distressing for the student and may be viewed as a failure of the admissions process or a lack of support by the school to ensure student success. While student dismissal is often associated with student characteristics such as academic performance prior to enrollment or during the nursing program, there was a dearth of studies that examined student dismissal from an in-depth analysis of the student's perspective.

PURPOSE

The purpose of this study was to describe and explore factors contributing to academic dismissal, particularly from the student's perspective.

METHOD

Using the lens of Critical Pedagogy, the investigator interviewed nine students dismissed from a baccalaureate nursing program. Students were asked to describe their experiences from the time they decided to pursue nursing school, during school, and after dismissal.

RESULTS

Findings of this study suggest that intrinsic and extrinsic factors that contribute to a student's choice of pursuing nursing warrant consideration, including a student's social and cultural factors prior to admission.

CONCLUSION

Results from this study may inform those faculty and the admissions team reviewing potential students for admission into a baccalaureate nursing program of essential factors to consider prior to offering admission. A holistic evaluation of the student with consideration of social and cultural factors and readiness for entrance into a pre-licensure nursing program is the goal of the admissions process.

Development and evaluation of a preparation model for the Indonesian nursing licensure examination: A participatory action research

BACKGROUND

The long-standing underachievement in the Indonesian national nursing competency examination (NNCE) has been a common concern, and there is limited information on the preparation program for this licensure examination.

OBJECTIVE

To develop an NNCE preparation program model and evaluate its effectiveness in increasing competency among nursing graduates.

DESIGN

A quasi-experimental study using participatory action research (PAR).

SETTING

Faculty of nursing of a full-boarding private university in Indonesia.

PARTICIPANTS

The participants were selected with the purposive sampling method. The 23 course coordinators and clinical instructors met the inclusion criteria of having worked for at least five years as classroom teachers and at least one year as course coordinators or clinical instructors. The 85 nursing graduates met the inclusion criteria of having finished the internship program and planned to take the NNCE.

METHODS

The model was developed using PAR and the evaluation done to measure the increase in the competency level and the level of perceived readiness and satisfaction of both the participant educators and nursing graduates.

RESULTS

The proposed model consists of core components and essential concepts. The core components are a holistic preparation process, active involvement and participation, knowledge and skill specialty, sharp examination-taking and skills, motivation to join the program and self-confidence to pass the NNCE, and time commitment for the preparation program. The essential concepts consist of awareness and trust, desire to change, sense of responsibility, mutual collaboration, equipped and empowered to act, definite direction and goals, mentoring. The model's evaluation indicated a significant increase in competency level, overall perceived readiness for the national nursing competency examination, and degree of satisfaction with the preparation program.

CONCLUSIONS

The implementation of the preparation model effectively increased the nursing graduates' competency level, and both the participating educators and nursing graduates were satisfied with its effectiveness.

Preparing for the new nursing licensure exam: The next-generation NCLEX

ABSTRACT

The National Council of State Boards of Nursing is changing its licensure exam to focus on a clinical judgment model. This article describes the current National Council Licensure Exam (NCLEX), the shift in focus from the nursing process to clinical judgment, and the intended emphasis of the next-generation NCLEX.

Academic and Nonacademic Predictors of BSN Student Success on the HESI Exit Exam

First-time success rate on the NCLEX-RN examination has significant implications for BSN students, faculty, and schools of nursing. Many nursing programs utilize standardized examinations such as the HESI Exit Exam to quantify student success on knowledge of nursing concepts and to prepare students for success on the NCLEX-RN. Nursing faculty must be able to identify predictors of student success early in the nursing program in order to offer appropriate support and remediation. The purpose of this retrospective, correlational study was to determine predictive variables of BSN student success on the HESI Exit Exam in a southeastern university. Students who reported higher test anxiety scored significantly lower on the HESI Exit Exam. Higher medical-surgical I HESI examination scores, higher medical-surgical II HESI examination scores, higher obstetrics HESI examination scores, and higher final grade point average were significant predictors of students' HESI Exit Exam scores and accounted for 39% of the variance in the scores. Results from this study suggest implementing remediation based on HESI Specialty Exam scores and interventions aimed at reducing test anxiety.

The Effects of Augmented Reality on Prelicensure Nursing Students' Anxiety Levels

BACKGROUND

Prelicensure nursing students experience high anxiety as they enter the clinical setting, which can have a negative impact on learning care performance and critical thinking. This study explored the viability of an innovative technological teaching strategy, augmented reality (AR), as a platform to prepare students and decrease their anxiety levels when entering a new environment.

METHOD

A pretest/posttest quasiexperimental design was used to assess the effect of AR 360 photosphere on preli-censure nursing students' anxiety levels as they entered a new clinical environment compared with anxiety levels of prelicensure nursing students who participated in the traditional faculty-led orientation method.

RESULTS

Students from three midwestern colleges of nursing completed the State-Trait Anxiety Inventory before and after completing the AR 360 photosphere orientation or a faculty-led orientation. An independent t test revealed no difference in students' anxiety levels between the two methods of orientation.

CONCLUSION

Although there were no significant differences in nursing students' anxiety levels between the two methods of clinical orientation, the AR 360 can be a valuable method of orientation that saves faculty time and ensures more consistent and uniform content compared with the traditional faculty orientation method. [J Nurs Educ. 2020;59(3):142-148.].

Using the Angoff method to set a standard on mock exams for the Korean Nursing Licensing Examination

PURPOSE

This study explored the possibility of using the Angoff method, in which panel experts determine the cut score of an exam, for the Korean Nursing Licensing Examination (KNLE). Two mock exams for the KNLE were analyzed. The Angoff standard setting procedure was conducted and the results were analyzed. We also aimed to examine the procedural validity of applying the Angoff method in this context.

METHODS

For both mock exams, we set a pass-fail cut score using the Angoff method. The standard setting panel consisted of 16 nursing professors. After the Angoff procedure, the procedural validity of establishing the standard was evaluated by investigating the responses of the standard setters.

RESULTS

The descriptions of the minimally competent person for the KNLE were presented at the levels of general and subject performance. The cut scores of first and second mock exams were 74.4 and 76.8, respectively. These were higher than the traditional cut score (60% of the total score of the KNLE). The panel survey showed very positive responses, with scores higher than 4 out of 5 points on a Likert scale.

CONCLUSION

The scores calculated for both mock tests were similar, and were much higher than the existing cut scores. In the second simulation, the standard deviation of the Angoff rating was lower than in the first simulation. According to the survey results, procedural validity was acceptable, as shown by a high level of confidence. The results show that determining cut scores by an expert panel is an applicable method.

More than a cultural experience: Assessing the impact of a medical-surgical international clinical on nursing students' academic performance

A review of the extant literature suggests that there remains a dearth of evidence regarding the evaluation of well-defined outcomes related to international nursing clinical experiences. The purpose of this study was to explore the relationship between students' clinical experience (traditional versus international) and a number of academic outcomes including final medical-surgical course grades, performance on relevant Assessment Technologies Institute (ATI) proctored exams, and National Council Licensure Examination (NCLEX) pass rates. A non-experimental design was implemented using retrospective data obtained from a small university in the Midwest. Students complete a medical-surgical clinical in India during the interim of their third semester in the nursing program. Results of the t-tests show a statistically significant difference in final grades for Adult Health II theory when comparing students who completed a traditional clinical (M = 83.1, SD = 3.8) with those who completed an international clinical (M = 81.6, SD = 5.2); t(100) = 2.0, p = .043. The difference in mean scores for traditional clinical students (M = 70.3, SD = 6.6) versus international clinical students (M = 66.2, SD = 7.2) for the Adult Medical-Surgical proctored exam reached statistical significance, t(119) = 4.5, p ≤ .001. In contrast, there was no significant difference in means scores between the two groups with regard to scores on the Comprehensive Predictor proctored exam (traditional clinical, M = 76.1, SD = 5.9; international clinical, M = 75.2, SD = 6.4); t(121) = 1.0, p = .316. Finally, a chi square test of independence found that the relationship between clinical status and performance on NCLEX was not statistically significant, χ² (1, N = 197) = 0.132, p = .716. Further research is needed to examine the impact of international clinicals on a broader range of outcomes including academic, cultural competency, and clinical performance measures.

Regulation of nursing professionals in Cambodia and Vietnam: a review of the evolution and key influences

BACKGROUND

In 2006, the countries of the Association of Southeast Asian Nations (ASEAN) signed the Mutual Recognition Arrangements (MRA) in relation to nursing services in the region. This agreement was part of a set of policies to promote the free flow of skilled labor among ASEAN members and required mutually acceptable professional regulatory frameworks. This paper presents a narrative review of the literature to (1) describe progress in the development of the regulatory framework for nursing professionals in Cambodia and Vietnam since 2000 and (2) identify key factors, including the MRA, that affect these processes.

METHODS

For document review, policy documents, laws, regulations, and published peer-reviewed and gray literature were reviewed. Data were triangulated and analyzed using a tool developed by adapting McCarthy et al.'s regulatory function framework and covering eight functions (legislation, accreditation of preservice education, competency assessment, registration and licensing system, tools and data flow of registration, scope of practice, continuing professional development, professional misconduct and disciplinary powers).

RESULTS

Cambodia and Vietnam have made remarkable progress in developing their regulatory frameworks for nursing. A number of key influences contributed to the development of nursing regulations, including the signing of the MRA in 2006 and the establishment of the Joint Coordinating Committee on Nursing (AJCCN) in 2007 as key milestones. Macroeconomic and political factors affecting the process were economic growth and an emerging private sector, social demand for quality care and professionalism, global attention to health workforce competencies, the role of development partners, and regular monitoring and mutual learning through AJCCN. A period of incubation enabled countries to develop consensus among stakeholders regarding regulatory arrangements; this trend accelerated after 2010 by bringing national regulatory schemes into conformity with the regional framework. Some similarities in the process (e.g., preservice education first, legislation later) and differences in key actors (e.g., professional councils and the capacity of nursing leaders) were observed in two countries.

CONCLUSION

Further development of the regulatory framework will require strong nursing leadership to sustain achievements and drive continued progress. The adapted tool to assess regulatory capacity works well and may be of value in assessing the development of regulations in the nursing profession.