The Complex Challenge of Improving NCLEX Pass Rates

By Susan Sportsman, PhD, RN, ANEF, FAAN

The September 2017 Collaborative Momentum Consulting blog “What were the program’s NCLEX scores this year?” sparked a considerable amount of discussion: clearly this is a critical issue for many nursing education programs. The blog noted that “there are many factors influencing students’ success on the NCLEX exam, some of which faculty cannot control.” In that article, I focused on three challenges that faculty can influence: curriculum; teaching-learning activities; and appropriate construction of test questions. Faculty intervention for these challenges can make a significant difference in student success on the NCLEX examination.

Nursing faculty and administrators also know that those issues that are influenced by students’ choices, such as academic preparation and student engagement, will certainly impact the program’s first-time NCLEX pass-rate. If the program’s first-time pass rate dips below the standard set by the state Board of Nursing, the program will be held accountable to improve the scores. Structures must be put in place to address some of those student-focused challenges, such as academic preparation and student engagement. Some of these structures include:

• Admission and progression policies
• Remediation processes
• Testing policies

Admission criteria are a starting point for improving first-time NCLEX pass rates. Nursing is a rigorous course of study requiring a broad breadth of knowledge for successful practice. For example, the student must be able to grasp both the concepts of basic and social science and integrate them into the care of the WHOLE patient. Although we want to be sure that there are sufficient numbers of nurses to care for our citizens in the future and we also want the nursing program’s students to represent the diverse population the nurse will care for, we must also be sure that those admitted to our programs have the academic acumen to be successful in meeting the rigors of the curriculum.

To insure success in the program and the NCLEX, some nursing programs set very high admission standards. This assures that most of the students admitted will be successful on the NCLEX, but it also may limit the size of the undergraduate nursing program. These programs may not be able to contribute sufficiently to the production of the number of nurses that will be needed in the future.

Other colleges and universities may have missions which foster excellence but are not exclusive; for example, the university where I was Dean recruited a wide range of students, many of whom were first generation or non-traditional college students. These students may not have had all the preparation required for the nursing curriculum; yet with assistance, most were able to be successful.

My own undergraduate academic story reflects such a situation. An honors high school graduate from a small town in east Texas, I entered a large state university with the declared major of nursing. Imagine my shock (and that of my parents) when I brought home my first semester grades: one B, one C, and three D’s. I will admit I had a great time in the social arena that semester, because I thought I could study like I studied in high school and still make good grades. Turns out that approach didn’t work!  Fortunately for me, in those days, once you were admitted to pre-nursing, you were eligible to continue into the nursing program, as long as you stayed in school—no additional admission requirements were necessary. I had some help learning how to study and went on to successfully graduate and pass the NCLEX. However, do you know how long it takes to bring up your GPA when you have three D’s to contend with?

Nursing programs that want to admit students who have potential (like my 18-year-old self) but may have poor prerequisite course GPAs or have other limitations in their nursing application, may establish more specific admission criteria or “formulas” for admission. This approach is often the answer to admitting a diverse, yet qualified cohort. However, to insure that these students are successful, the school must also provide an organized remediation process that supports “at-risk” students and establishes markers for progression.

Nurse educators may be concerned that including more specific criteria in the admission policy to offset the lower prerequisite grades or depending upon remediation programs to improve student performance may have negative results on the program’s NCLEX first-time pass rate. One strategy to allay these concerns is to develop a strong testing policy that fosters excellent faculty–made tests, academic honesty, and the use of a standardized testing program. Implementing such policies will insure valid test scores that accurately monitor student preparation for NCLEX-type examinations throughout the curriculum. Such accurate data of student performance will allow the program’s remediation processes to specifically address individual student needs.

Even when these principles are followed, nurse educators must pinpoint specific challenges in their program that should be a priority for intervention. Given the complexity of factors that influence the first-time NCLEX pass rates, where and how do we begin? My experience as a faculty, Dean and nursing education consultant is that when the first-time pass rate begins to fall, we use a scatter-shot approach. We recognize that the problem is complex and that it is difficult to identify the challenges that have the greatest impact on student failure. Relevant data to support necessary action may be hard to come by and faculty and administrators may not have time to carefully evaluate the data that is available. So we typically use our collective intuition to choose the interventions for improvement. I can certainly remember times when my nursing faculty and I identified every possible influencing factor and planned an intervention for each. It seemed like a good idea to be thorough, but as you can probably imagine, the solutions to our problem were often too complex to implement quickly or effectively!

Time plays a large role in the implementation of interventions to improve a program’s NCLEX first-time pass rate. Finding sufficient faculty time to gather data and agree on appropriate interventions while managing the day-to-day responsibilities can be daunting. In addition, in many cases changes in policy often require approval beyond the nursing program level. As a Provost I once was reported to have said, “Colleges and universities change with the speed of a glacier.” Approval of your recommendations by the appropriate committees requires time—time you may not have as the next cohort moves closer to graduation and taking the NCLEX examination.

The most effective approach to improving the first time NCLEX pass rate is to implement best practices related to admission standards, curriculum, teaching-learning processes, testing policies, and remediation, always considering the mission of the program and the profile of the students who apply to your nursing program. It is also important to maintain an ongoing evaluation plan that provides the necessary data to help prioritize the challenges that must be addressed.

When my department faced complex challenges I found it was often useful to bring in an outside expert to help us sort out our situation and develop an effective plan to address our challenges. A consultant could bring an objective perspective to the faculty and commit the time needed to find a workable solution. However, I found that these experts were often focused on addressing one issue when what we really needed was for someone to diagnose our situation and offer prioritized solutions to expedite our progress towards improving first-time NCLEX pass rates.

This need for a quick program diagnosis and assessment led Collaborative Momentum Consulting to develop a new service to help nursing programs prioritize processes that are not effective  and develop more efficient strategies to improve the NCLEX scores of the greatest number of your students. Check out our website to learn more about this opportunity to efficiently and affordably address challenges that keep your students from being successful on the NCLEX examination.

Best wishes for continued improvement in your NCLEX first-time pass rate in 2018!

Susy

Selected References

Davis, J. (2016) Faculty roles and processes for NCLEX-RN Outcomes:  A Theoretical Perspective.  Teaching and Learning in Nursing 11 (4) 171-174.

Farley Serembus, J. (2016). Improving NCLEX First-Time Pass Rates: A Comprehensive Program Approach. Journal of Nursing Regulation. 6 (4), 38-44.

Geist, M., Catlette, M. (2014) Tap into NCLEX success. Teaching and Learning in Nursing. 9 (3) July, 115-119.

Koestler, D. L. (2015). Improving NCLEX-RN First Time Pass Rates with a Balanced Curriculum. Nursing Education Perspectives. 36 (1), 55-57.

Lown, S., Hawkins, L. (2017) Learning Style as a predictor of first-time NCLEX-RN success: Implications for Nurse Educators. Nurse Educator. 42 (4) 181-185.

Massachusetts Board of Registration in Nursing (2017) Strategies for improving NCLEX Pass Rates: A summary of nursing education program findings and interventions as reported to the Arizona, California, and Massachusetts Boards of Nursing. https://www.mass.gov/files/documents/2017/10/06/Strategies%20for%20Improving%20NCLEX%C2%AE%20Pass%20Rates.pdf. Accessed December, 2017.

Mee, C., Schreiner, B. (2016) Remediation in nursing education today: Review of the literature and considerations for future research. Journal of Nursing Regulation. 7 (1) April, 37-45.

Texas Board of Nursing (2008) Texas Board of Nursing report on strategies utilized by Texas nursing educational programs to improve candidates’ performance on the NCLEX Examination.  https://www.bon.texas.gov/pdfs/education_innovation_pdfs/edudocs/rpt-strategies-nclex.pdf  Accessed December, 2017.