by Susan Sportsman, PhD, RN, ANEF, FAAN
Assessment, the starting point to an effective clinical judgment, is an important competency of nurses and other health care providers. When caring for patients, we use a wide range of assessment techniques, including review of the presenting complaint; health history; complete physical assessment; and family, social, and cultural history, to collect sufficient data to plan patient-centered care. However, we all know that in certain clinical situations, a complete assessment is not an appropriate strategy, because of the patient’s condition and/or limited time and resources available. In those situations, a focused assessment that delves into a specific identified problem or issue is more appropriate.
Skill in the process of assessment of an individual patient situation can be translated into assessment of groups, organizations, populations, and communities. For example, as nurse educators we must assess, in an efficient way, the complex needs of students who may be struggling to meet the requirements of their nursing programs. We must not only make an assessment of INDIVIDUAL students’ needs in order to provide assistance for their particular situation, but we must also assess the collective achievement of one or more cohorts of students in order to improve the curriculum and other experiences for the group as a whole.
Despite the need to address the collective needs of a group, this level of assessment is complex because of the different needs among members. How can we pinpoint the most effective interventions to address the needs of the majority, without spending an unreasonable amount of time on the assessment or using a poorly defined “scatter-shot” approach? Rather than choosing some number of factors that typically impact the desired outcome in a negative way, we must identify and prioritize, through a carefully designed and focused assessment, the challenges that have the greatest impact. This focus on identification and prioritization of our particular challenges reduces the time and resources required to address the problem and heighten the likelihood of improving the situation.
Collaborative Momentum Consulting (CMC) uses a particular decision-making framework, the proprietary VCST™, to address complex situations. It emphasizes the decision-making work required prior to implementing an intervention to resolve a problem. This approach has been successfully used in health care and community organizations in the US and abroad. Below is a schematic presentation of this process.
You may read more about this framework here.
As an example of the use of VCST™, let’s apply the framework to a challenge familiar to nurse educators: a poor first-time NCLEX pass rate. Imagine that you are responsible for improving the first-time NCLEX pass rate of your pre-licensure nursing program. Here is how the VCST™ framework might help you in this situation.
Scenario
The first-time NCLEX pass rate of your program has been drifting downward over the last three years and now is at a level that it is unacceptable to the program and the regulators. The first step is to define your vision; in this case, to identify the pass rate that faculty and other stakeholder believe is acceptable. Determining a vision that is achievable and measurable requires a discussion among the faculty and stakeholders to determine one that is aspirational, yet possible. Here is such a vision:
Vision: To achieve a first time NCLEX pass rate of 90% within two years.
To develop a plan to address the downward trend of the first-time NCLEX pass rate, the faculty must determine which of the multiple potential challenges to student success on the NCLEX examination is most prevalent in your program. Again, a focused assessment of the current situation in order to identify factors that best practices suggest improve a nursing program’s first-time NCLEX pass rate is required. The August, 2018 CMC blog provides you some steps to identifying the challenges that can affect a nursing program’s first-time NCLEX pass rate.
The focused assessment of our imaginary program finds that the primary challenges to an improved first-time NCLEX pass rate include:
Challenges:
- A lack of consistent processes to determine potentially “at risk” students
- Limited remediation processes available throughout the curriculum
Once the challenges specific to our imaginary nursing program are identified, the faculty must develop strategies and tactics which will effectively target these specific challenges. Best practice strategies for improving student success on the NCLEX are widely available in the literature and are the subject of the February, 2018 CMC blog.
However, even those interventions considered to be best practices within nursing education must be best for your individual program (and the individual students involved). In other words, the best practices chosen must fit the context. The faculty who understand the organizational culture and the resources available must be responsible for identifying challenges that have the highest priority, because they affect the largest number of struggling students. They must also identify what strategies and tactics are most likely to be successful given the availability of resources and organizational culture. Strategies identified by our imaginary program might include:
Strategies:
- Develop, implement, and evaluate a process to identify “at-risk” students.
- Develop, implement, and evaluate a formal referral process to the available retention resources.
Tactics are the action items that are developed to accomplish the strategy. In our imaginary program the following tactics might be developed:
Tactics: The Nursing Faculty Organization Student Affairs Committee will:
- Collect and analyze data to determine what factors (admission criteria, standardized test results, faculty tests, course grades, etc.) predict NCLEX failure for students in this program;
- Develop a process to use this data to identify “at risk” students in the program;
- Document the currently available remediation programs at this program;
- Develop a process to refer students appropriately to available programs;
- Evaluate the effectiveness of the remediation services annually.
Making decisions related to complex, organizational problems requires a structured approach, such as VCST™. This article provides an example of the use of the VCST ™ framework when addressing the problem of an unacceptable NCLEX first-time pass rates. However, it can also be used in a wide range of organizational problems.
Conclusion
To ensure that complex problems are addressed in a timely fashion, the assessment encompassed in the framework must be focused in order to identify and prioritize the challenges to be addressed. For more information on how Collaborative Momentum Consulting can help you identify and prioritize your program’s challenges to achieving an acceptable NCLEX first-time pass rate, visit our website.
Best wishes for a successful fall term!