By Susan Sportsman, PhD, RN, ANEF, FAAN
“Ashley” was admitted to a nursing program with several challenges. She had dropped out of high school at 15 because she was pregnant; she got married and had a baby at 16; and was divorced at 17. For years, she worked at low paying jobs to support her son, although her dream was to become a nurse. Her grades in high school were not great because she rarely went to class. Finally, at 30 years of age, encouraged by a nurse who was the mother of one of her son’s friends, she successfully completed a GED exam and slowly began to take the required courses to apply for a nursing program. Her grades, although not stellar, were sufficient to make her competitive for admission. Her math score on the admission test was extraordinarily high, despite a low reading comprehensive score, which made her admission possible.
Ashley struggled with the nursing curriculum. She barely passed her first-year courses, making low C’s in most of them. In her second year, the Nursing department initiated a remediation program, and despite some initial resistance, she participated throughout the remainder of her program. She was able to make B’s in all her courses, including the clinical courses, which she had struggled with initially. Even more importantly, she passed the NCLEX-RN.
Fast forward five years: Ashley has worked in a step-down unit since graduation, becoming a respected charge nurse on her unit. Her supervisor is encouraging her to enroll in the master’s program. As a result, she has taken the GRE, with scores that would allow her to easily be admitted.
Ashley’s story illustrates how a remediation program can make a difference when it is well-implemented. What does an effective remediation program look like? Let’s explore what effectiveness means in this context.
Students have responsibility for developing competencies required of a novice nurse. However, faculty have an equal responsibility for ensuring that structures and processes are in place to foster such competencies. Faculty must set admission criteria that will ensure that most students accepted to nursing programs can succeed. They also have an obligation to provide appropriate, evidence-based curriculum and teaching-learning activities. Of course, despite the faculty’s best efforts, things can go wrong. Even when the admission criteria are well thought-out, as students move through the program they may, like “Ashley,” experience academic challenges.
Principles of Effective Remediation
Confronting academic challenges of admitted students is one of the responsibilities of the nursing program. I believe nursing programs have an obligation to provide opportunities for students to improve their nursing knowledge through remediation programs. My nine years as a consultant (and my experience as a faculty and Dean) have cemented my beliefs regarding the importance of effective remediation. Here are my recommendations based upon my experience.
- Provide remediation opportunities as soon as students are admitted to the program. Use admission criteria to determine what students should participate in a formal remediation process. Of course, there may be students who may have personal situations, such as family trauma, who may need 1:1 assistance from an individual faculty for support. However, students who barely meet the admission criteria may need a more formalized support to address potential academic limitations. For example, a student like Ashley, with a low score in the reading comprehension section of an admission test despite an acceptable overall admission score, may need more formalized support to attack the mountain of reading required in nursing programs.
- Recognize that participation in a remediation process may carry a negative connotation—”The Nursing program faculty think I am not smart enough to be a nurse.” The faculty must minimize these perceptions. Choosing a positive name for the remediation program, perhaps something like “Student Success Program,” can be helpful. Equally important, faculty must reiterate the message that taking advantage of extra assistance is a smart way to become a successful nurse.
- Remediation policies must define when and how students may be referred to remediation as they progress through the program. For example, students who consistently do poorly on faculty-made or standardized tests likely need remediation support. Faculty and students must know how the referral process works and what is expected of students and their faculty.
- Develop policies that allow students who do well because of the remediation process to withdraw from the remediation process. After receiving support from the remediation program, students are likely to become more competent in taking tests and improve their skills in applying content and performing in lab and clinical experiences. As a result, the retention policies should identify when and how improving students might no longer participate in the remediation process.
- A responsible person must be appointed to coordinate the remediation effort and must be given the responsibility to follow up on students’ progress and document completion of the remediation activities. Some remediation programs give faculty who work with students in class or clinical the responsibility to remediate students. Other programs have a nursing faculty whose primary responsibility is to remediate students, as well as coordinate and document remediation activities. In addition, some programs offer additional remediation opportunities, such as peer mentorship, as specific remediation activities. Regardless of the structure of the remediation processes, I strongly recommend that program administration appoint one person to coordinate remediation activities and document student participation and outcomes.
- When a remediation coordinator is in place, faculty and the remediation coordinator must communicate effectively as students move throughout the remediation process. During my time as a nurse faculty and administrator, I have observed situations where faculty responsible for specific classes were not willing to refer students for remediation, because they believe they are responsible for their student’s progress and do not want other faculty involved. In my opinion, such behavior defeats the purpose of integrating remediation into the fabric of the nursing program and ultimately hurts student success.
Should students who are struggling academically be required to participate in a remediation process? Frankly, I am of two minds about this question. Individual students must be motivated to make changes in their behavior to be successful; as a result, “making” students participate is usually not helpful. On the other hand, I have also seen examples of students who went “kicking and screaming” into a remediation program, but came out the other end of the program as successful students—and crediting the remediation process as a reason for their success. I do believe that if faculty develops a remediation process that is fair, consistent, and engaging for students, it is usually not necessary to “make” students participate. Ultimately, however, this is a decision that the faculty organization must make.
How do we remediate students online during this Pandemic?
The pandemic has presented challenges for us all—students and faculty alike. Imagine if in addition to the stress associated with the challenges of a nursing program, you had to deal with challenges resulting from poor academic preparation, burdensome family or economic issues, or concern regarding the health of those you love. In these circumstances, remediation support becomes even more critical. Here are some thoughts regarding providing such support when interaction at a distance is necessary.
- Faculty and administration must develop and implement a plan for offering remediation from afar. Likely this will include contact via Zoom or other similar technology. Faculty must make every effort to engage students in the remediation process. Using Zoom break-out rooms for students to virtually interact with each other and discuss issues and challenges will encourage student engagement.
We all know that interacting via technology from our homes is less formal than interacting in a classroom. Afterall, it is hard to be formal when your child—or cat—wanders into the screen’s focus. This can be a positive (and often funny) experience and can help to bring the group together. In a recent issue of the Chronical of Higher Education, a faculty described recording her lecture for a virtual class. She said, “My dog barked during the recording. Rather than re-record, I said, “my dog is contributing to the lecture.” She commented, “I didn’t stop and rerecord. The dog barking makes me real to students. I am not just this person who is a content expert. I am at home doing a lecture with my dog in the background.” (McMurtrie, 2020).
- Use technology (or even the telephone) to hold frequent office hours, so students can be in touch with faculty as frequently as they need support. Be proactive, reaching out to the students early and often, even if they are not asking for help (McMurtrie, 2020). The need for contact may be more frequent than remediation in person, particularly in an emergency such as COVID-19. This frequent contact allows students to express concerns in a safe environment and then hopefully make a plan to cope.
- Answer emails rapidly. A colleague who runs a remediation program recommends answering emails daily. Where previously we might have answered emails on a 48-hour basis or even longer, now that all faculty are at their computers (or other devices) almost all the time, being available on a same-day basis to students who need remediation via email is required to provide the support students may need.
Remediation is critical in assuring success of students who may need a hand-up to become a nurse. Let us all remember that students who participate in remediation often go on to successful careers. We do not want to lose these potential students, even during this time of a pandemic.
I would love to hear your experiences with successful remediation, In the meantime, be well and stay safe!
McMurtrie, B., (2020) The new rules of engagement. Teaching. The Chronicle of Higher Education. October. https://www.chronicle.com/article/the-new-rules-of-engagement. Accessed, November, 2020