Analyzing the Problem: The First Step in Improving NCLEX First-Time Pass Rates

by Susan Sportsman, PhD, RN, ANEF, FAAN

The final results of first time NCLEX-pass rates are in—and you and your nursing faculty colleagues are concerned.  There has been a significant drop in the first-time pass rate of your program compared to the year before.  Inconsistent pass rates have occurred for the last ten years.  What can be done?

When situations like this occur, the response for faculty and administration is often to address every potential area of concern immediately and all at one time.  The impetus is to act quickly, making as many changes as possible to address potential reasons for the drop in the NCLEX pass rate and demonstrate the program’s intent to improve the first time pass rate. After all, the Board of Nursing in your state (to say nothing of the college/university administration) will soon expect an action plan to address the decline in the pass rate.

So, in an effort to demonstrate a readiness to attack the problem, you and your faculty convene to identify possible problems that may have influenced the drop and suggest solutions to counteract them.     Here is what might happen in such a situation:

• A number of faculty members point to the fact that the program increased the number of students admitted to the cohort that most recently took the NCLEX examination. The program had sufficient faculty to cover the clinical experiences for the increased number of students, but perhaps other support systems had been insufficient for the numbers of students admitted. Solution: Reduce the number of slots available for each admission period.
• Some of the faculty expresses concern about serious and pervasive cheating among students in the program, particularly in the cohort that recently graduated. Solution: Develop a stringent anti-cheating policy.
• Other faculty members believe that those students who do not do well on the NCLEX may have problems taking multiple choice tests.  Solution: Require students (at least, the “at-risk” ones) to complete a certain number of multiple-choice test questions as practice prior to graduation.
• Still other faculty members believe that there is insufficient time for didactic and clinical experience in medical-surgical nursing classes.  Solution: The curriculum committee proposes a reduction in the number of semester credit hours allotted to Community Health Nursing and transfers those credit hours to the medical-surgical courses.

It is not that the above solutions are inappropriate as part of a tool box that faculty may use to improve their programs’ first-time NCLEX pass rate. However, it would appear that this group of faculty immediately began suggesting solutions to the low first-time pass rates, rather than pausing and using relevant data to determine the multiple causes that influence the pass rates. This is not an unusual occurrence – I can recognize these behaviors in my own experience as a Dean.

I once worked for an administrator, who, when our first-time NCLEX pass rate dropped, said, “Susy, just admit the smart students!”  Since this administrator was my boss, I smiled as sweetly as I could manage.  In my head, I was thinking, “Tell me exactly how to identify the smart students, specifically those that will be effective nurses, and I will get right on it!” Despite the advice of my boss, the bottom line is that poor NCLEX scores are multi-causal and can best be dealt with through effective analysis and prioritization of next steps.

In the clinical world, when there is an event which results in significant patient harm, a Root Cause Analysis (RCA) is implemented.  The RCA takes a structured, systems-oriented approach to identify what happened (the course of events), why the incident happened (the root cause, or causes), those causes that seemed to have the greatest impact, and ways to prevent the problem from occurring in the future. This approach has been used since the 1990s in health care, and changes have been made to the process and the name changed to Root Cause Analysis and Action (RCA2) to emphasize that the outcomes of the root cause analysis—the corrective actions and resulting risk mitigation (Gupta, Lyndon, 2017).

Those of us who are nurse educators might benefit from using a similar approach when dealing with the need to improve a program’s NCLEX first-time pass rates. All of us can agree that factors that influence  pass rates  in any nursing program is a complex phenomenon and the outcome is impacted by multiple influences, some seen and some unseen. Scores in a program will NOT be corrected by a simple solution. To insure that the complexity of the causative factors is considered, the following strategies can provide an effective protocol for improving student scores.

1. Take a deep breathe when you hear that your NCLEX first-time pass rate is below your expectations. Consider all of the factors that may have influenced this outcome.
2. Identify those processes, from admission scores and grades of various courses to scores on exit examinations, which may reflect students’ progress throughout the program.
3. Develop data collection processes that will determine the effectiveness of the policies that govern student progress. For example, tracking how well students score on various aspects of the admission criteria and comparing these with their NCLEX scores can provide an evaluation of the effectiveness of your admission process.
4. Review the effectiveness of the processes, such as the teaching-learning activities or the remediation programs, which support student learning.

Once this assessment process has been completed, determine which factors, based on the data analysis, seem to have the greatest impact upon your program’s first-time NCLEX pass rate.  It is not possible to immediately resolve all the issues you have identified; thus prioritization of the areas of concern is essential.  Once you have determined those concerns, the solutions can be designed and implemented.

The need to identify and prioritize the processes that are not effective in supporting NCLEX success led Collaborative Momentum Consulting to develop a new service to help nursing programs identify and prioritize effective strategies to improve the scores of the greatest number of students.  Check out our website to learn more about this opportunity to efficiently and affordably address challenges that prevent your students from achieving NCLEX success.

References

Gupta, K., Lyndon, A. (2017) Rethinking Root Cause Analysis.  Perspectives on Safety.  January. PSNet.  Agency for Healthcare Research & Quality (AHRQ). U.S. Department of Health and Human Services.  https://psnet.ahrq.gov/perspectives/perspective/216/rethinking-root-cause-analysis  Last accessed, June, 2018.