NURSING EDUCATION programs in Texas must achieve an annual first-time National Council Licensure Examination (NCLEX-RN) pass rate of at least 80% to maintain good standing with the state board of nursing. During the Fall 2016 semester, the Amarillo College Associate Degree Nursing (ADN) Program, with an approximate enrollment of 325 students, experienced a decline in NCLEX-RN pass rates that resulted in a state board of nursing warning. This article chronicles Amarillo College's journey through the identification and implementation of curriculum improvement strategies, resulting in dramatic and sustained improvements in NCLEX-RN pass rates.
In April 2013, the National Council of State Boards of Nursing (NCSBN) raised the passing standard on the NCLEX-RN. The logit, which is a statistical unit of measurement, was raised from -.16 to .00 with the implementation of the 2013 NCLEX-RN Detailed Test Plan.1,2 The Detailed Test Plan provides nursing programs with educational content guidelines.
The NCSBN raised the passing standard because of an RN Practice Analysis in 2011 designed to ensure that nursing programs were educating graduates with the knowledge, critical-thinking skills, and clinical reasoning skills to provide safe care as patient-centered scenarios grew more complex.
3 Consequently, the NCLEX-RN became more difficult to pass. The higher passing standard required nursing programs to evaluate and improve their curricula to better prepare graduates to pass the NCLEX-RN. We define curriculum as the total program of a planned sequence of teaching and learning strategies in the advising, admission, progression, and graduation of nursing students.
An indication that curriculum problems were present in our program was that the first-time NCLEX-RN pass rate dropped from 91.23% in 2011 to 84.51% in 2012. In 2011, clinical learning began to emerge as a problem. In our current clinical instruction model, students were often unprepared to administer medications and prioritize care.
Nurses and nursing managers expressed dissatisfaction with comments such as, “Amarillo College doesn't provide basic care like it used to,” “Students spend too much time writing in the conference room with their current clinical model,” “Students spend all of their time in critical thinking and don't think a bath is important,” and “Amarillo College students used to come the day before clinical to get their patient information and were prepared when they arrived to the unit.”
An analysis of the academic progression of students who graduated in December 2011 and May 2012 was conducted. These two graduating cohorts constituted the 84.51% NCLEX-RN pass rate for 2012. A curriculum analysis was also simultaneously implemented.
The Health Education Systems, Inc. (HESI) Admission Exam (HESI A2) is an admission process tool. The HESI A2 is a standardized computerized examination that many nursing programs use to measure a nursing student applicant's aptitude in such areas as reading comprehension, vocabulary and general knowledge, grammar, and mathematics.
The HESI A2 is a reliable predictor of a student's success in nursing school. The analysis of student data indicated that the mean HESI A2 scores were slightly lower for students who comprised the December 2011 and May 2012 graduating cohorts than for previous cohorts, especially in the exam's vocabulary component. The analysis of student data also indicated that graduates who averaged final course grades from 70% to 73% in the last two semesters of the program were more likely to fail the NCLEX-RN than students with higher grades.
An analysis of our curriculum indicated that graduate performance was declining in the areas of basic care and comfort, pharmacology and parenteral therapies, and nursing process. We also found gaps in testing rigor among the four program levels. The ADN Program faculty define rigor as having a curriculum that's current in practice standards, evidence-based, coherent and logically applied through the program, and sufficiently challenging to ensure the achievement of program outcomes.
Policies established by the ADN Program Testing Committee weren't being consistently applied, especially in the use of the test blueprint and in test item construction and analysis.
The focus for improvement in 2012 included the following:
Strongly encourage potential applicants to seek tutoring at the college in preparation for the HESI A2 after attending a program admission advising session.
Require students to consult with the instructor if they don't pass an exam with a grade of C. A grade of C was 70% to 79% at this time.
Ensure that all faculty follow the clinical nursing process guidelines, including the use of the rubrics for the clinical evaluation tool and nursing care plan, and skills competency checklists.
Ensure that all faculty provide the structure necessary for students to gather patient information on the first day of clinical, including, but not limited to, instruction on the use of the nursing care plan guidelines and a detailed orientation to the nursing unit.
Ensure rigor of test items and use of the testing blueprint by consistently following policies. For example, ensure that most items on a test are at the higher cognitive levels of application and analysis (80% of items) and that knowledge and comprehension items constitute no more than 20% of the test.