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Increasing graduate success on the CAT version of the NCLEX -RN

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Increasing graduate success on the CAT version of the NCLEX -RN

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INCREASING GRADUATE SUCCESS ON THE CAT
VERSION OF THE NCLEX-RN
by
Ronda M. Wood
A Dissertation Presented to the
FACULTY OF THE ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment o f the
Requirements for the Degree
DOCTOR OF EDUCATION
April 2002
Copyright 2002 Ronda M. Wood
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UMI Number: 3073865
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UNIVERSITY OF SOUTHERN C/, JFORNIA
School of Education
Los Angeles, California 90089 0031
This dissertation, written by
o n d a On - i ^ o o d __________
under the direction ofh&L-Dissertation Committee, and
approved by all members o f the Committee, has been
presented to and accepted by the Fact, ty of the School
o f Education in partialfulfillment of the requirements for
the degree of
D o c t o r o f E d u c a t io n
M arch 12.. £ 503-
Dissertation Committee
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ACKNOWLEDGMENTS
I would like to express my appreciation to several people who were involved in
the completion of this dissertation. First, I wish to extend my gratitude to my committee
chairperson. Dr. Linda Hagedom, who guided me through this process. I also want to
thank my committee members. Dr. Maurice Hitchcock and Dr. Lawrence Picus, for
their expertise. I thank Dr. Lois Ramer for giving the project a nursing perspective.
Second, I want to thank my friends for their encouragement and support. I thank
Dr. Shirley Naret, who was always there to give me a gentle nudge when I felt like giv
ing up and for always listening when I needed to talk. I thank Ginger Nazarian for her
great support with phone calls from Arizona. I thank Dr. Brenda Harrell for allowing
my data collection and for her support. I thank Darleen Peters for her assistance in lo
cating some of the study participants. Although she is not here to see my completed
work, I thank Patricia Collins for having the right word or phrase when I needed it.
Lastly, I would like to thank my family. I thank my mother. Rose Honnell. for
her continued belief in me and her support. I thank my stepfather, Don Honnell, for his
support. I thank my brother and sister-in-law, Rick and Diana Wood, for their under
standing. I thank my nephew Brandon and my niece Nicole for always understanding
when “Auntie” could not play because she had to work on her paper.
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TABLE OF CONTENTS
Page
ACKNOWLEDGMENTS ...................................................................................... ii
LIST OF TABLES..................................................................................................... v
ABSTRACT............................................................................................................... vii
Chapter
1. INTRODUCTION ..................................................................................... 1
Background of the Problem................................................................ 1
Statement and Significance of the Problem....................................... 4
Purpose of the S tu d y .......................................................................... 6
Assumptions of the S tu d y .................................................................. 6
Limitations of the Study .................................................................... 7
Definition of Term s............................................................................ 7
Advisory Committee .................................................................. 7
Associate Degree in Nursing (ADN) Program........................... 7
Computerized-Adaptive Testing (CAT)..................................... 8
English 1 .................................................................................... 8
English 105 ................................................................................ 8
Generic Student.......................................................................... 8
Lead Teacher.............................................................................. 8
LVN-to-RN Student.................................................................... 9
National Council Licensure Examination for Registered
Nurses (NCLEX-RN).......................................................... 9
Nursing Program Courses .......................................................... 9
Transfer Student.......................................................................... 9
2. REVIEW OF THE LITERATURE .......................................................... 10
3. RESEARCH METHODOLOGY.............................................................. 41
Research Population.......................................................................... 41
Research D esign................................................................................. 42
iii
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Chapter Page
Instrumentation.................................................................................. 50
4. FINDINGS................................................................................................... 51
Quantitative Data................................................................................ 51
Qualitative Data.................................................................................. 67
5. DISCUSSION............................................................................................... 80
Study Objective, Research Question, and Background
Information.................................................................................. 80
Summary of Study Results ................................................................ 81
Limitations ......................................................................................... 92
Conclusions......................................................................................... 92
Implications of the Study.................................................................... 93
Recommendations for Future Research.............................................. 95
REFERENCES ......................................................................................................... 97
APPENDICES............................................................................................................. 104
A. RESEARCH ON PREDICTORS FOR SUCCESS ON THE
CATNCLEX-RN............................................................................... 105
B. RESEARCH ON PREDICTORS FOR SUCCESS ON THE
PAPER-AND-PENCIL NCLEX-RN ................................................ 107
C. PREPARATION FOR THE NCLEX-RN ............................................... 115
D. NCLEX-RN DISSERTATIONS ............................................................. 117
E. PAPER-AND-PENCIL TESTING VERSUS C A T ................................. 121
iv
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LIST OF TABLES
Table Page
1. Prerequisite Courses ................................................................................... 44
2. Corequisite C ourses.................................................................................. 45
3. Demographic Attributes o f S ubjects.......................................................... 53
4. Prerequisite Courses Taken by Subjects................................................... 54
5. General Educational Background of Subjects ......................................... 56
6. Elapsed Time Between Graduation and NCLEX-RN............................... 57
7. Chi-Square and Fishers Exact for Demographics Versus Pass/
Fail....................................................................................................... 59
8. Age at Graduation Versus Pass/Fail on First Attempt: t T est................... 59
9. Total and Biology Prerequisites Versus Pass/Fail on First Attempt
on NCLEX-RN: rTest ...................................................................... 60
10. Chi-Square and Fisher’s Exact for General Educational Back
ground Versus Pass/Fail .................................................................... 62
11. Grade Point Average Versus Pass/Fail on First Attempt on
NCLEX-RN: t T est............................................................................. 62
12. Time (Elapsed Months) Between Graduation and Taking the
NCLEX-RN Versus Pass/Fail on First Attempt: t Test ................... 64
13. Multivariate Logistic Regression to Predict NCLEX-RN Outcome 64
14. Multivariate Logistic Regression to Predict NCLEX-RN Outcome.
With English Class Omitted .............................................................. 66
v
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ABSTRACT
This study explored the topic of preparing nursing school graduates for the
Computerized-Adaptive Testing (CAT) version of the licensure examination for regis
tered nurses (National Council Licensure Examination for Registered Nurses or
NCLEX-RN). The objective of the study was to answer the following research ques
tion: How can nursing school faculty prepare graduates for the computerized version of
the licensure exam?
The study involved both qualitative and quantitative research. The sample for
the study consisted of graduates, faculty, administrators, and the advisory committee of
a community college Associate Degree in Nursing program in the western United
States. Demographic data were collected from the student files of program graduates
from May 1994 to May 2000. The following data were collected: gender; age; ethnic
ity; nursing course grade point average; prerequisite courses grade point average;
whether the graduate was a generic student, transfer student, or Licensed Vocational
Nurse to Registered Nurse student; and whether the graduate passed or failed the
NCLEX-RN. A discriminate analysis was performed to look for differences between
the graduates who passed the NCLEX-RN the first time and those who did not pass the
first time. Focus groups and interviews were utilized to gather information from pro
gram graduates, administrators, faculty, and the advisory committee.
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CHAPTER 1
INTRODUCTION
The study explored the topic of preparing community college nursing school
graduates for the computerized version of the licensure examination for registered
nurses. The objective of the study was to answer the following research question: How
can nursing school faculty prepare graduates for the computerized version of the li
censure examination? In the following paragraphs the history of the National Council
Licensure Examination for Registered Nurses (NCLEX-RN), a description of Com
puterized-Adaptive Testing (CAT), and the relevance of preparing graduates to be suc
cessful on the NCLEX-RN are discussed.
Background o f the Problem
The NCLEX-RN was developed by the National Council of State Boards of
Nursing (NCSBN), which is composed of representatives from each of the state boards
of nursing. The examination is designed to measure licensure candidates' knowledge.
It is also used to determine whether a candidate can react and respond appropriately to
problems commonly encountered by a registered nurse (RN) in typical clinical settings.
It is structured so that the state boards of nursing can be reasonably assured that
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individuals who pass the examination are minimally competent to practice as entry-
level RNs (NCSBN, 2002).
Over the years, many changes have been made to the NCLEX-RN. It has pro
gressed from an examination divided into specialty sections (such as pediatrics,
medical-surgical obstetrics, etc.) to a 2-day test with all specialties blended. Each of
these changes has posed new challenges for the candidates. The most recent change was
in April 1994, when the examination became computerized. It is now given via com
puter at various test sites. The computerized version requires approximately 4 hours to
complete.
CAT uses computer technology and measurement theory. Each candidate's test
is unique because it is assembled interactively as the individual takes the test. As the
candidate answers a question, a competence estimate is calculated, based on all earlier
answers. The test bank is then scanned and the next question is selected to measure the
candidate's knowledge more precisely in the appropriate test plan area. This process
creates a test tailored to each candidate's knowledge and skills while fulfilling all test
plan requirements (NCSBN, 2002). At some point during the examination the compe
tence estimate becomes sufficiently precise to determine, within a known degree of
confidence, whether the candidate possess the minimum competence necessary to
practice as an entry-level RN. The examination terminates at that point.
“The goal of computerized adaptive testing (CAT) is to determine your compe
tence, based on the difficulty of the questions you can answer correctly, NOT how many
questions you can answer correctly5 ’ (NCSBN, 2002, n.p.). The computer starts with a
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relatively easy question and, if that question is answered correctly, a somewhat more
difficult question is presented. As long as the candidate answers correctly, the questions
become more difficult. When the candidate starts to answer incorrectly, the questions
become easier until the candidate answers correctly; then more difficult questions are
presented. This continues until a competence level is reached at which the candidate
can answer approximately 50% of the questions correctly. After each question the com
petence and error band (region within which the candidate’s competence level might
vary if the candidate answered more questions) is calculated. With CAT the candidate
is not allowed to go back to change answers to previously answered questions or to skip
questions because the computer scores each question as it is answered and selects the
next question based on the answer to the previous one (Educational Testing Service
Network. 1999).
After the minimum number of questions (75 for the NCLEX-RN) have been
answered, the computer makes one of three decisions. First, the candidate is clearly
above the pass standard and the examination is passed and ends. Second, the candidate
is clearly below the pass standard and the examination is failed and ends. Third, the
competence rate is close enough to the passing standard that it is not clear whether the
examination is passed, and so the examination continues. Nevertheless, the examina
tion will end when the maximum number of questions (265 for the NCLEX-RN) have
been presented, or when the time limit (5 hours for the NCLEX-RN) has been reached
(NCSBN, 2002).
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Statement and Significance o f the Problem
Pass rates on the NCLEX-RN are very important to schools of nursing. "Nurs
ing faculty and students must be concerned about individual accomplishment and insti
tutional pass-fail rates on the [NCLEX-RN]” (Billings et al., 1996, p. 272). The
measure of the success of a school of nursing is its NCLEX-RN pass rate. The number
of students graduated from a program is inconsequential in comparison to the NCLEX-
RN pass rate. If students complete the program but do not pass the licensure examina
tion, they will not be allowed to practice as RNs. "Although a student may obtain an
academic degree in nursing, the individual cannot become a registered nurse until the
licensure examination is passed” (Billings et al., p. 272). If schools of nursing are con
cerned only about their graduation rate, they are ignoring the most important measure of
their success. NCLEX-RN pass rates are not only the best measure of success for
schools of nursing, but the ability of the schools to remain open depends on them.
"Successful NCLEX-RN graduate pass rate must be maintained for continued institu
tional program viability” (Billings et al., p. 272).
Schools of nursing serve not only students; they also serve hospitals in the com
munity by providing new nurses. When the hospitals have available positions, nurse
mangers most often look to the students who have served on their units. With the cur
rent nursing shortage, new graduates are being hired at a high rate because there are not
enough experienced nurses to fill the positions. In order for new graduates to be suc
cessful, hospitals must provide extensive orientation programs.
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After a NCLEX-RN candidate completes the examination, she/he is issued an
interim permit. That permit allows the new graduate to work as a RN under the supervi
sion of experienced RNs until the license arrives. New graduate orientation programs
are very expensive for hospitals, but the investment is well worth it to obtain new staff
with fresh outlooks and new ideas. If the interim permittee fails the licensure examina
tion, she/he must be terminated, and the money spent on orientation is wasted. There
fore, hospitals look to nursing programs with high examination pass rates from which to
hire their new RNs.
Schools of nursing have regulations imposed on them by a regulatory board
called the Board of Registered Nursing (BRN). The BRN accredits nursing education
programs. When the BRN members come to the school for an accreditation visit, one of
the criteria examined is the program's NCLEX-RN pass rate. If the pass rate is low
compared to other programs, the program director and faculty of the program must pro
vide an explanation for the situation and describe measures that they will take to in
crease the pass rate. If the pass rate does not improve, the BRN may consider disciplin
ary measures for the program. If the program loses its accreditation or has it suspended,
the program must close its doors until the deficiencies are addressed to the BRN's sat
isfaction.
As a result, NCLEX-RN pass rates are extremely important to every school of
nursing. Faculty must explore how to identify students at risk for failure of the exami
nation to intervene early and to help each one to increase her/his chances of success. It
is much easier to intervene with at-risk students than to help them after they have failed
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the examination. First-time test takers have the best success rates on the examination
(NCSBN, 2002).
Purpose of the Study
Since the CAT version of the NCLEX-RN has been in place for only 6 years,
there is limited research on candidate success on the examination. In order for nursing
school faculty to assist graduates in being successful on the examination, baseline data
must be gathered on predictors for success and identification of groups who are at risk
for failure on the examination. From the perspective of one school of nursing, this study
will begin to explore how to prepare graduates to be successful on the NCLEX-RN.
The data from the research will be utilized to begin to explore how to increase the first
time pass rates on the examination and will lead to implications for future research.
Assumptions o f the Study
For this study, the following assumptions were made:
1. The data were accurately recorded and analyzed.
2. The participants responded to the best of their ability.
3. In order to enhance student success on the NCLEX-RN, the study will
benefit the involved school of nursing by providing suggestions for curriculum im
provement.
4. The findings of the study will be applicable to other nursing programs.
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Limitations o f the Study
The following are possible limitations of the study:
1. The study was limited to subjects who voluntarily agreed to participate.
2. Due to the fact that only one associate degree program was utilized for the
sample, the study cannot be generalized to all schools of nursing and 4-year baccalaure
ate degree programs.
3. The sample size is small compared to the population of candidates who have
taken the CAT version of the NCLEX-RN since 1994.
Definition of Terms
The following is a list of key terms for the study:
Advisory Committee
A committee composed of representatives from local health care organizations.
The committee functions to advise the school of nursing in areas such as curriculum and
admission criteria.
Associate Degree in Nursing (ADN)
Program
A 2-year program offered at a community college to prepare graduates to take
the registered nursing licensure examination and to obtain an Associate of Science
degree.
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Computerized-Adaptive Testing (CAT)
Testing that utilizes computer technology and measurement theory to administer
a standardized examination.
English 1
Expository and persuasive writing based on college-level reading, research, and
critical thinking. According to the course catalog of the subect community college, this
course transfers to schools in the University of California system and the California
State University system
English 105
The study and performance of writing to enable the student to express ideas
clearly in essay form, using standard written English. According to the course catalog
of the subect community college, this course meets the composition requirements for
Associate of Arts and Associate of Science degrees and may prepare students for Eng
lish 1.
Generic Student
A student who enters in the first semester of the nursing program.
Lead Teacher
a faculty member who is responsible for coordinating a semester of the nursing pro
gram.
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L VN-to-RN Student
A Licensed Vocational Nurse (LVN) who comes into the RN program in the
third semester.
National Council Licensure Examination
fo r Registered Nurses (NCLEX-RN)
RN licensure examination developed by the NCSBN, which is composed of
representatives from each of the state boards of nursing. The examination is designed to
measure licensure the candidate’s knowledge and to determine whether a candidate can
respond to problems encountered by an RN.
Nursing Program Courses
Nursing courses required for the ADN program utilized in the sample. It is a 2-
year nursing program, and each semester is divided into two 9-week courses: (a) 11A—
first semester fundamentals of nursing, (b) I IB—first semester medical-surgical nurs
ing, (c) 12 A—second semester surgical nursing, (d) 12B—second semester medical
nursing, (e) 21A—third semester women’s health nursing, (f) 21B—third semester
mental health and medical-surgical nursing, (g) 22A—fourth semester pediatric and
adult ICU nursing, and (h) 22B—fourth semester leadership.
Transfer Student
A student who transfers to a nursing program from another nursing program.
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CHAPTER 2
REVIEW OF THE LITERATURE
A literature review was completed to understand the history and development of
the NCLEX-RN, predictors for success on the examination, and computerized testing.
There are many studies in the literature on the topics of computerized testing and the
NCLEX-RN. These studies can be categorized as follows: (a) predictors for success on
the NCLEX-RN. (b) preparing students for the NCLEX-RN, (c) dissertations on the
NCLEX-RN. and (d) comparing paper-and-pencil testing to computerized testing. This
chapter summarizes those studies.
It is well documented that, if predictors for success can be identified for the
nursing licensure examination, faculty can identify students who are at risk for failing
the examination and intervene with them (Ashley & O’Neil, 1991; Dell & Valine. 1990;
Felts, 1986; Foti & DeYoung, 1991; Fowles, 1992; Frierson, Malone, & Shelton. 1993:
Huepel, 1994; Jenks, Selekman, Bross, & Paquet, 1989; Lengacher & Keller, 1990;
Waterhouse, Bucher & Beeman, 1994; Woodham & Taube, 1986). Because of the re
cent implementation of the CAT version of the NCLEX-RN in 1994, only two studies
were found that explored predictors for success on that version of that examination
(Briscoe & Anema, 1999; Roncoli, Lisanti, & Falcone, 2000; see appendix A).
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However, there are numerous studies on predictors for success on the paper-and-pencil
version of the examination (see appendix B). That literature may assist faculty in
schools of nursing to identify predictors for the CAT version of the licensure examina
tion and thus help faculty to enhance students’ chances of success on the test.
Much research has been published on predictors for success on the paper-and-
pencil version of the NCLEX-RN, which was administered from 1982 to 1994. Candi
date success on the NCLEX-RN is of concern to nursing students/graduates, nursing
faculty and school administrators, boards of trustees, the general public, and local hos
pitals. "Preparing for taking licensing examinations continues to be a priority for both
nursing students and their faculty” (Riner et al., 1997, p. 255). The NCLEX-RN pass/
fail rates are important to both nursing school faculty and graduates. Successful pass
rates are needed for a school of nursing to remain open. Agencies that accredit nursing
programs look at the pass rates as a large part of the accreditation process and, without
the proper accreditation, the program is closed. Students must complete their nursing
programs and pass the NCLEX-RN in order to practice as RNs. The following para
graphs discuss research on predictors for success on the paper-and-pencil version of the
NCLEX-RN.
Dr. Jay Breyer (1984) did a study to look at the National League of Nursing
(NLN) Comprehensive Nursing Achievement Test as a predictor of performance on the
NCLEX-RN. The NLN is an accrediting body for registered nursing programs. This
accreditation is recommended but not mandatory for the programs. The NLN has de
veloped several paper-and-pencil examinations that can be given to students to test their
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knowledge in various subject areas (such as women’s health, mental health, and pediat
rics). The NLN Comprehensive Nursing Achievement Test can be given near the end of
the program to test students’ readiness for the licensure examination. The following is
the design of Breyer’s study. Results on the NLN Comprehensive Nursing Achieve
ment Test given in 1982 to 2,496 associate degree and diploma nursing students were
compared with the July 1982 NCLEX-RN results on those same students. The sample
appeared to perform slightly better on the examination than the entire population of
first-time test takers for the NCLEX-RN. Second, a 1993 equating sample was used.
Eight hundred sixty-one students from associate degree and diploma programs were
utilized. The NCLEX-RN scores from this group were equated back to the 1982 valida
tion sample. The 1982 group showed a strong correlation between success on the NLN
test and the NCLEX-RN. The 1983 group appeared to have the same relationship. The
study data found that the NLN Comprehensive Nursing Achievement Test predicted
success on the NCLEX-RN.
Faculty members at the University of Iowa have published three studies looking
at predictors of success on the NCLEX-RN (Glick, McClelland, & Yang, 1986; McClel
land, Yang, & Glick, 1992; Yang, Glick, & McClelland, 1987). The purpose of the first
study was to look at the relationships among admission selection variables, achievement
in a baccalaureate nursing program, achievement in clinical nursing courses, and pre
dicting success on the NCLEX-RN. Data were collected from the records of 51 gradu
ates. Variables were age, gender, transfer from another university, high school rank and
grade point average (GPA), composite American College Testing (ACT) scores, grades
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from all prerequisite and nursing courses, and NCLEX-RN scores. For the admission
criteria, pre-nursing GPA and biology GPA were the best predictors for achievement in
the nursing program. The only actual nursing course grade that was significant in pre
dicting NCLEX-RN success was Nursing III (the third semester clinical nursing course).
The correlations observed supported the use of high school rank, chemistry GPA. bi
ology GPA, sociology GPA, and pre-nursing GPA as selection criteria for admission to
the nursing program.
The second study was designed to look at the relationship between admission
variables (high school rank, ACT subtest and composite scores, and cumulative GPA
for pre-nursing courses) and achievement in the nursing program and performance on
the state board examination. Records of 210 graduates of a baccalaureate nursing pro
gram who took the NCLEX-RN from 1983 to 1985 were reviewed. The results showed
that admission variables correlated with NCLEX-RN scores. The success in the pro
gram and on the licensure examination may be predicted by academic performance in
high school, college entrance tests, and pre-nursing GPA.
The third study was to validate results of the previous two studies, using a
statewide sample. The subjects for this study were 1,069 graduates of baccalaureate
nursing programs in Iowa. The first component of the third study looked at the relation
ships between admission variables and achievement in the nursing programs and perfor
mance on the Mosby Assess Test (developed by the Mosby publishing company to as
sess nursing students’ readiness for the licensure examination) and the NCLEX-RN.
The second component looked at the extent to which achievement in nursing courses
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predicted performance on the NCLEX-RN. The third component used analysis to de
scribe the relationships among the variables in the study. In summary, the study results
indicated that pre-nursing GPA and ACT test scores can predict future academic perfor
mance in baccalaureate nursing programs and on the NCLEX-RN.
Woodham and Taube (1986) explored predictors for success on the NCLEX-RN
in an ADN program. Records of 107 graduates from an associate degree nursing pro
gram who took state board exams for 1982 to 1983 were reviewed. The researchers
looked at age at graduation, high school percentile. Scholastic Aptitude Test (SAT)
scores, and nursing course grades, and they compared them to NCLEX-RN scores.
Faculty also taught a review course for the graduates. High SAT scores and nursing
course grades correlated positively with NCLEX-RN pass rates. The rest of the vari
ables did not significantly correlate with passing the examination.
Felts (1986) studied the relationship of nursing course grades, ACT scores, and
high school GPA to success on the NCLEX-RN. There were 297 subjects who took the
NCLEX-RN between July 1982 and February 1984. There were five study hypotheses.
The first hypothesis was that there would be no significant admission variables useful in
predicting the GPA in the nursing courses. The second hypothesis was that there would
be no significant cognitive variables (grades in support courses, GPA in the humanities,
the biological/physical/social sciences, and the support courses) useful in predicting the
GPA in the nursing courses. The third hypothesis was that there would be no cognitive
variables (high school GPA, ACT scores, and college GPA) that significantly discrimi
nate those students who do not pass. The fourth hypothesis was that there would be no
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difference between age groups in the proportion of students who passed the NCLEX-
RN. The fifth hypothesis was that there would be no difference between unlicensed
students and licensed practical nurse (LPN) students in the proportion of those who pass
the NCLEX-RN.
The following are the results of the tested hypotheses. First, there were no sig
nificant admission variables (high school GPA and ACT scores) useful in predicting the
GPA in nursing courses. Second, there were no significant cognitive variables (grades
in support courses or all of the non-nursing courses that are required during the nursing
program, or GPA in the humanities, biological, physical and social sciences) useful in
predicting the GPA in nursing courses. Third, there were no cognitive variables (high
school GPA. ACT scores, grades in support and nursing courses, and college GPA) that
significantly distinguished students who will pass the NCLEX-RN from those who will
not. Fourth, there was no difference between age groups in the proportion of students
who pass the NCLEX-RN. Fifth, there was no difference between unlicensed students
and LVNs who pass the NCLEX-RN. The findings of the study were that (a) the ACT
composite score and support course GPA were the best admission criteria, (b) perfor
mance in college courses predicted NCLEX-RN success better than did high school
GPA, and (c) grades in the support courses differentiated between those students who
passed the examination and those who failed the examination.
Krupa, Quick, and Whitley (1988) studied the effectiveness of nursing course
grades in predicting NCLEX-RN performance. Data were obtained from the records of
359 graduates of a baccalaureate nursing program. Nursing course grades were
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assigned points (A = 4, B = 3,C=2, D =l,F = 0) and the grade averages were com
pared to the graduates’ passing or failing the state board examination. The students who
passed the examination had higher grade averages than those who did not pass. Further
analysis revealed that grades in the introductory nursing course taken in the sophomore
year made the largest contribution to predicting pass/fail on the NCLEX-RN. The
grades in the practicum/clinical courses had a weaker relationship to NCLEX-RN suc
cess than did those in the theory courses. The researchers concluded that nursing course
grades show great promise as predictors of performance on the NCLEX-RN.
Feldt and Donahue (1989) reported on their study for predictors of success on
the NCLEX-RN. They included 155 students who completed and 34 who did not com
plete a baccalaureate nursing program from 1984 to 1986. They found that the best pre
dictors were nursing GPA, ACT composite score, anatomy grade, and chemistry grade.
The best predictors for NCLEX-RN success were ACT composite score, high school
percentile rank, nursing GPA, and chemistry grade. The researchers suggested that
further research was needed in the area to define other variables that discriminate be
tween students who will pass and those who will fail the NCLEX-RN.
Jenks et al. (1989) determined predictors for success on the NCLEX-RN and
sought to determine optimal timing for identifying students at risk for failure on the ex
amination. University nursing students from 1984 to 1987 were the sample for the
study. The independent variables were previous university GPA, total number of credits
earned prior to being in the nursing program, previous university science GPA, level of
previous university attended, theory grades for the six clinical nursing courses, student
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age at graduation, student gender, and raw score on the Mosby Assess Test. The de
pendent variable was the score on the NCLEX-RN. The score on the Mosby Assess
Test showed the strongest relationship with the dependant variable. The second stron
gest relationship came from grades in the first five nursing theory courses. The best
point to identify students at risk for failure on the NCLEX-RN was found to be the
senior year; however, since that is too late for intervention, the researchers felt that the
junior year was the best time for intervention. Future research must be done to see what
types of intervention could be used to enhance graduate performance on the test.
A study published in 1990 (Lengacher and Keller) examined the relationships
among admission variables (entrance GPA. ACT scores in English and math, and com
posite ACT scores), age, perception of role strain, achievement in clinical and nursing
courses, achievement on NLN exams, exit GPA, and NCLEX-RN performance. One
hundred forty-six graduates of an ADN program who took the state boards in July 1987
and July 1998 were used as the study sample. The researchers had four hypotheses: (a)
no significant relationship between admission selection criteria and performance on the
NCLEX-RN, (b) no significant relationships among nursing theory grade, clinical
grades, and performance on the NCLEX-RN, (c) no significant relationships among
NLN test scores and the end of the first year and performance on the NCLEX-RN, and
(d) no significant relationships among age, perception of role strain, and performance on
the NCLEX-RN. The study results showed that all of the variables were significantly
related to NCLEX-RN success. Upon admission, students could be identified to be at
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risk for failure on the NCLEX-RN and early intervention could be done. No sugges
tions were made as to the type(s) of intervention(s) that might be done.
Dell and Valine (1990) studied other variables in addition to academics that
might predict success on the NCLEX-RN. The study participants were 78 senior nurs
ing students. The researchers gathered information on college GPA, SAT/ACT scores,
age, and self-esteem. Self-esteem was measured via the Tennessee Self-Concept Scale
(TSCS), the Draw-A-Person (D-A-P), and the Gergen-Morse Self-Consistency Mea
sure. These variables were then correlated with NCLEX-RN scores. As other studies
have shown, GPA was found to be the best predictor of success on the NCLEX-RN.
Self-esteem was found to be a poor predictor of success on the examination. College
GPA explained 58% of the variance in state board examination scores and other vari
ables contributed 6%; however, more studies are needed to find out what accounts for
the remaining 36%. The researchers suggested that the study be replicated with differ
ent measures of self-esteem and other personality measures.
Ashley and O’Neil (1991) studied an intervention to promote success on the
NCLEX-RN. Thirty members of a senior class of baccalaureate nursing students partic
ipated in the study. They were identified as being at risk for failure on the examination.
The criteria for identifying the participants at risk were meeting one or more of the fol
lowing criteria: nursing GPA of 2.4 or below, Mosby Assess Test ranking at or below
the 20th percentile, and a diagnosed learning disability. Fourteen of the 30 students
participated in an intervention program, and 16 did not participate due to conflicts in
course schedules (2 of the 16 did not have NCLEX-RN results available, and therefore
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only 14 were used for the study). The intervention program began in the senior year and
was 5 months in length. A total of 10 meetings were held. The intervention sessions
utilized a test-coaching approach that included taking a focused nursing examination,
correcting it, and then reviewing the content material contained in the test. A compari
son was made between the two groups, using the 28 candidates. Out of 14 who partici
pated in the intervention program, 13 (92%) passed the exam. Out of 14 in the compari
son group, who did not participate in the intervention program, only 7 (50%) passed.
The study findings were that long-term intervention can improve the NCLEX-RN pass
rates of at-risk students.
Horns, O’Sullivan, and Goodman (1991) obtained data from the records of 394
baccalaureate nursing graduates who took the NCLEX-RN between February 1985 and
July 1986. They compared race; gender; admission GPA; grades for the second, third,
and fourth years of nursing school; and NLN test percentile with NCLEX-RN scores.
The authors suggested that admission GPA may be used to place students into remedi
ation programs. The type of remediation program in which a student would be placed
could be determined by further skill testing, such as testing reading and mathematics
ability. The nursing courses can identify students who need more help. Nursing faculty
must continue to study timing for key indicators to plan interventions to help to enhance
graduate success on the state board examination. Further research is needed to identify
curricular characteristics of nursing courses that relate to student performance on the
NCLEX-RN and the relationship of student characteristics to nursing curricular charac
teristics. All of this future research may be helpful in designing remediation programs.
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Faculty at William Patterson College in New Jersey published a study in 1991 that
looked at predictors for success on the NCLEX-RN (Foti & DeYoung, 1991). The sam
ple was 298 nursing students who graduated between 1985 and 1988. The researchers
compared the following variables with the NCLEX-RN pass or fail scores: Mosby As
sess Test, overall GPA. major GPA, NLN test scores, SAT verbal scores, science course
GPAs. and SAT quantitative scores. The SAT verbal scores. Mosby Assess Test, and
overall GPA were found to be the most useful predictors for success on the NCLEX-
RN. Because of the correlation between NCLEX-RN success and SAT verbal scores,
the faculty decided to continue to administer the Nelson-Denny Reading Test before the
student begins the nursing courses, and to refer to the Learning Enhancement Assistance
Program all students who score below the fifth stanine/percentile or who have a reading
rate below 220. The Mosby Assess Test would continue to be administered, and faculty
members would counsel students as to the correlation of their score and NCLEX-RN
pass/fail.
Fowles (1992) used a sample of 192 senior nursing students to measure relation
ships between grades, ACT scores, and Mosby Assess Test scores and pass/failure on
the NCLEX-RN. The students used in the study had graduated from a baccalaureate
nursing program between 1985 and 1988. The best predictors of success on the
NCLEX-RN were found to be the GPA after the initial quarter for nursing courses,
percentile on the Mosby Assess Test, grade in anatomy and physiology, and either ACT
social science subscale or ACT composite score. The researchers suggested that each
nursing program study its own predictors for success on the state licensure examination.
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The need to develop early intervention programs to enhance the success of at-risk stu
dents in the nursing program and on the NCLEX-RN was clearly identified. The au
thors stated that more research was needed in this area.
Mills, Becker, Sampel, and Pohlman (1992) studied predictors for success on
the NCLEX-RN for graduates of an accelerated baccalaureate program. For the study,
328 graduates from 1982 to 1990 were the sample. The researchers compared the fol
lowing variables to NCLEX-RN pass or fail: gender, education in foreign nursing pro
grams, mean age, mean transfer GPA, and mean GPAs at end of the nursing program’s
first, second, and third semesters. The study findings were as follows. The GPA at the
end of first semester could predict failure 94% of the time. With each increase of a
grade by the end of the second semester, the candidate had 46 times better chance of
passing the exam. American-educated candidates had 4.5 times better chance of pass
ing the NCLEX-RN than foreign-educated candidates. At the end of the third semester,
with each letter grade increase on the final GPA, the candidate had 97 times greater
likelihood of passing the exam.
Rami (1992) looked at the importance of four predictor variables in predicting
success on the NCLEX-RN: pre-nursing GPA, ACT scores, comprehensive examina
tion scores, and scores on the Basics (I) NLN Achievement Test. Thirty-five graduates
of a baccalaureate nursing program were used for the study. The Basics (I) NLN test
scores were found to be significant predictors of success for the NCLEX-RN, but the
other variables were not found to significantly predict NCLEX-RN success. It was
recommended that the study be repeated with a larger sample.
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Huepel (1994) looked at GPA as a predictor for success on the NCLEX-RN. A
sample of 152 students who completed a baccalaureate nursing program between 1985
and 1987 was used. The dependent variable was score on the NCLEX-RN and the in
dependent variables were end of freshman year GPA, end of sophomore year GPA, end
of junior year GPA, end of senior year GPA, exit GPA or total program GPA, theory
grades for five prerequisite science courses, and theory grade for each nursing course.
The study findings showed that all of the independent variables were significant in pre
dicting pass/fail scores on the NCLEX-RN; however, the GPA at the end of the junior
year was the best predictor for success on the examination.
Waterhouse et al. (1994) cross-validated a previous study that had identified
predictors for success on the NCLEX-RN. One hundred forty-two graduates from 1991
to 1992 were used for the study. The predictors used were SAT scores, high school per
centile, pathophysiology grade, second junior nursing course grade, first senior nursing
course grade, last nursing clinical grade, American Nursing Review (ANR) course,
sophomore grade point index, graduation grade point index, probation, years to com
plete the program, change of major, and transfer status. More than 62% of the failures
and 87% of the passes were correctly categorized.
Faculty at Indiana State University did a 5-year study to look at graduate perfor
mance on the NCLEX-RN (Alexander & Brophy, 1997). They studied data from grad
uate records of those who graduated from July 1988 through February 1994. They
looked at selected admission and curriculum variables and NLN Comprehensive
Achievement Test scores in relationship to NCLEX-RN results. The strongest
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indicators of success were SAT verbal scores, nursing GPA, and NLN Comprehensive
Achievement Test scores.
Endres (1997) compared NCLEX-RN success rates for African American,
foreign-born, and White baccalaureate program graduates. Endres utilized a sample of
baccalaureate graduates who had graduated from four schools between May 1987 and
May 1992. She sought to determine relationships between nine selected variables
(nursing school admission GPA, medical-surgical nursing GPA. nursing cumulative
GPA, final cumulative GPA at graduation, percentile rank on the Mosby Assess Test,
age at the time of graduation, number of semesters needed to complete the nursing cur
riculum, prior licensure as a vocational nurse, and number of D’s and F’s received in
nursing courses) and success on the NCLEX-RN. A random sample of 50 African
American, 50 foreign-born, and 50 White graduates from three private and one state
NLN-accredited baccalaureate school in Texas were used. The results of the study in
dicated the following. First, ethnicity was not related to performance on the NCLEX-
RN. Second, students who received D’s and/or F’s on nursing courses were more likely
to fail the NCLEX-RN than were those who did not receive these grades. Third, those
with Mosby Assess Test percentile ranks below 21 were more likely to fail than those
with ranks above 20. Fourth, graduates who passed the NCLEX-RN were more likely
to have significantly higher GPAs than those who failed. Fifth, African American
graduates who passed were more likely to require significantly more semesters to com
plete the nursing curriculum than were passing foreign-born and White graduates;
failing African American graduates also needed more semesters to complete the
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curriculum than did failing White graduates. Sixth, foreign-born graduates who failed
the NCLEX-RN required more semesters to complete the curriculum than did those
who passed; they also needed more semesters to complete the nursing curriculum than
did failing African American and White graduates. Seventh, the number of D’s and F’s
in nursing courses significantly discriminated between passing and failing NCLEX-RN
for African American graduates. Eighth, the number of D’s and F’s significantly dis
criminated between passing and failing the NCLEX-RN for foreign-born and White
graduates.
In 1998, Arathuzik and Aber published research looking at success on the
NCLEX-RN. The actual date of data collection is not given; however, there is no men
tion of CAT in the article, and the literature focuses on the fact that little research had
been done since the 1988 implementation of the pass/fail grade on the NCLEX-RN.
The purpose of the study was to identify factors associated with success on the NCLEX-
RN. The study looked for relationships between internal blocks (multiple role strain,
self-doubt, disorganization, poor study habits, low motivation, emotions, fatigue, and
self-induced stress), external blocks (finances, family demands, family health problems,
lack of support, demands of work, living arrangements, and strains in relationships), and
other variables (undergraduate program cumulative GPA and sense of competency) and
pass/fail on the NCLEX-RN. In summary, their findings were that students who had
higher cumulative GPA, spoke English as their primary language, and had fewer inter
nal and external blocks had higher pass rates on the examination than did the other
students.
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A study by Barkley, Rhodes, and Dufour was published in 1998. The descrip
tion of the study participants does not mention their date of graduation; no mention is
made about computer testing. This study correlated nursing school course grades (pedi
atric, psychiatric mental health, adult health I & II, critical care, and obstetrical nursing)
and NLN test scores (adult, psychiatric, obstetrical, and pediatric tests). Positive rela
tionships were found between earning a grade of B or better in nursing clinical and
theory courses and high NLN Achievement test scores and passing the NCLEX-RN.
Therefore, the authors summarized that earning a C or lower grade combined with low
NLN test scores identified students who were most at risk for failing the NCLEX-RN.
Based on the study findings, they developed the NCLEX-RN Risk Appraisal Instrument
(RAI). This can be used by nursing school faculty to identify students who are at risk
for failing the NCLEX-RN and intervene to increase the chances of their passing the
examination. Interventions such as weekly meetings with faculty and tutoring were
suggested.
Studies were found that predicted success on the CAT version of the NCLEX-
RN. Briscoe and Anema (1999) examined the records of 38 May 1997 ADN graduates
from a public urban university in the southern United States. Their independent vari
able was success on the NCLEX-RN in relationship to six dependent variables: pread
mission GPA, failure of nursing courses, score on the NLN I (Adult Health Care Across
the Community Part I), score on the NLN-H (Adult Health Care across the Community
Part II), age, and race. Results of the study showed the following. The higher graduates
scored on the NLN-I and NLN-II, the better their chance of passing the NCLEX-RN.
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Older graduates were more likely than younger ones to pass the examination. Graduates
who were African American were more likely than those who were White non-His-
panic, Black non-Hispanic, or Hispanic to fail the NCLEX-RN. The researchers identi
fied factors that might aid nursing school faculty in identifying students at risk for
failure of the NCLEX-RN. However, the authors also stated that more studies were
necessary to determine predictors for success on the examination.
Roncoli et al. (2000) published a study comparing a stratified random sample of
19 baccalaureate nursing graduates who passed the NCLEX-RN and 19 students with no
records of passing the examination. In the two groups, there were no differences in age
or type of program in which they were enrolled. There was a significant difference in
GPA for the two groups. Students with A’s and B’s in science prerequisites and upper
division nursing courses were significantly more likely to have evidence of passing the
examination than were those who had received C’s or had repeated courses.
Once the CAT version of the NCLEX-RN was implemented, nursing faculty re
alized that they would need to prepare students differently for the CAT than for the pre
vious paper-and-pencil exam (see appendix C). Articles have been published which
discuss preparation of students for the NCLEX-RN. Colombraro (1989) studied a group
of 143 candidates to find out what were their main concerns about taking the NCLEX-
RN. The top three concerns were being unprepared/lacking knowledge, failing, and
running out of time. The author suggested that faculty encourage graduates to have
positive thoughts about the examination, such as to write notes to themselves that they
will pass. She also stated that the nursing faculty should encourage candidates to take a
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review course and/or study with review books. Educators may want to consider facili
tating study groups for graduates to assist them in preparation for the NCLEX-RN.
Even with all of this preparation, students should be encouraged to spend time alone
preparing for the examination.
Baradell, Durham, Angel, Kaufman, and Lowdermilk (1990) developed an aca
demic advisement program in 1985 that was designed for students at risk for failure of
the NCLEX-RN. Student identified as being at risk for failure on the examination are
referred to the program. They are taught a decision-making model to assist them in an
swering questions.
Ashley and O’Neil (1994) studied the effectiveness of study groups in prepara
tion for the NCLEX-RN. Out of the 100 study participants, 65 participated in faculty-
directed study groups and 35 did not participate. The study findings supported that
study groups were helpful in assisting students to pass the licensure examination.
In 1995, Dr. Patricia Beare, Professor of Nursing at Louisiana State University
Medical Center School of Nursing, published an article that gave information on assist
ing students to prepare for the CAT version of the NCLEX-RN. She had the following
suggestions. First, faculty must instill confidence in students and assist them in decreas
ing their anxiety. Faculty should encourage students to set up a study schedule and form
study groups. Second, faculty should teach the students the following hints for taking
multiple-choice examinations: budget time, move at a steady pace, read each question
thoroughly, concentrate on one item at a time by focusing on the computer screen, focus
on key items in the stem, read all answers, use logic and common sense to figure out the
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correct response, and make sure that the answer selected fits the stem and is grammati
cally correct. Third, faculty and students should evaluate computer preparation pro
grams for the NCLEX-RN. Fourth, some preparation seminars taught by teachers are
helpful in studying for the exam. Fifth, content review books can be used for study. All
of these are merely suggestions for student preparation for the NCLEX-RN; they are not
research based.
Two articles presented reviews of several computerized NCLEX-RN prepara
tion programs (Billings et al., 1996; Riner et al.. 1997). Computerized NCLEX-RN
preparation programs were actually developed in the early 1980s and gained popularity
in 1994 with the implementation of the CAT version of the NCLEX-RN. Eight pro
grams were reviewed by Billings et al. (1996): COMPASS-RN, HESI Assess Test,
NLN-CAT-RN Comprehensive Q & A, Meds, Inc. Comprehensive Q & A, Mosby’s
NCLEX Review, Medi-Sim Computer-Assisted Preparation tor NCLEX-RN. NLN-
CAT Practice RN, and Preparing for NCLEX-RN-CAT. Each program was reviewed
for the following: (a) program design features (such as practice and test questions,
adaptive testing, references); (b) questions (following the NCLEX test plan, quality,
quantity); (c) question feedback (rationale for correct and incorrect answers, ongoing
progress report); (d) student performance report (on-screen progress report, printout);
(e) faculty report (individual student, group report); (f) screen design (layout similar to
NCLEX, color, keyboard use similar to NCLEX); (g) ease of use (directions clear, easy
to load program on computer); (h) technical support and documentation (online support,
documentation); (i) review based on demonstration disk or full program; (j) available
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for DOS, Windows 3.1, Windows 95, or Mac system requirements (graphics support,
mouse support, memory, ability to run on a Limited Access Network); (k) warranty and
upgrade policy; (I) price; (m) publications date and license agreement; (n) number of
work stations permitted; and (o) educational discount. Excellent data were presented;
however, no recommendations were made as to which program was the best program or
whether any of the eight programs were better than the others.
Riner et al. (1997) reviewed four preparation programs: Building Test Success
for Beginning Nursing Students, NCLEX-RN Success: Advanced Q & A, NLN Prac
tice Challenge, and RN-C AT 2.4. These programs were reviewed utilizing the same
criteria as the previous study: however, in addition, the following criteria were re
viewed: hints in practice mode, hard disk space required, monitor requirements, avail
ability in 3.5” diskettes or CD-ROM, and security for students’ reports/progress and
network.
In addition to the published studies that have been presented previously, there
have been dissertations on the subject of predictors for success on the NCLEX-RN (see
appendix D). Abstracts of the dissertations were reviewed, and the following are sum
maries of the studies.
A 1987 dissertation by Phillips sought to determine the relationship of test anxi
ety and certain demographic variables to performance of graduates on the NCLEX-RN.
The following were the independent variables used for the study: marital status, test
anxiety, minority status within nursing class, income level of parents, number of sib
lings attending and/or completing college, number of children, number of siblings,
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sibling rank, means of completing high school, number of years in college, age, gender,
which parents had lived during the student’s childhood, race/ethnicity, educational level
of parents, and parents’ participation in community activities. Eighty-seven senior bac
calaureate nursing students were used for data collection during spring and summer of
1984. School records were reviewed and the students completed a questionnaire. The
highest correlations for poor NCLEX-RN performance were test anxiety and marital
status. The researcher concluded that test anxiety was only one of many variables that
may have influenced NCLEX-RN test performance.
Neuman (1991) utilized data from 332 graduates of a community college up
ward mobility program (or LVN-to-RN program) from 1982 to 1990. Both admission
criteria and academic achievement indicators were used. The actual variables were
ACT composite scores, admission GPA. nursing course grades, non-nursing course
grades, cumulative GPA, and NLN Achievement Test scores. There were two purposes
of the study: (a) to examine predictors of academic achievement as found in the litera
ture and their relationship to NCLEX-RN performance, and (b) to analyze the variables
for their ability to differentiate between performance of LVN-to-RN students and
generic students on the NCLEX-RN. The study findings showed differences between
the LVN-to-RN group and the generic RN group and the variables that predicted suc
cess on the NCLEX-RN. The findings supported giving LVNs advanced standing in
upward-mobility RN programs. Neuman suggested that the study be replicated with a
larger sample using noncognitive variables.
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Stright (1992) described the relationship between selected academic and demo
graphic variables o f205 associate nursing graduates and their performance on the
NCLEX-RN. She also sought to determine whether there was an optimal time for in
tervention for students identified at risk for failure on the licensure examination. The
differentiating factors for those graduates who passed the NCLEX-RN and those who
failed were: generic or transfer students failed more than LVNs, and more transfer stu
dents failed than did generic or LVN students. Implications were drawn from the study
to determine identification of at-risk groups and to plan interventions for those students.
In 1996, Stevens completed a dissertation on nursing graduates in West Virginia be
tween 1985 and 1994. The purpose of the study was to look at the relationship of
faculty qualifications and program attributes to student outcomes. The independent
variables of the study were highest academic degree held by the faculty, years of teach
ing experience and clinical experience of the faculty, faculty/student ratio in class and in
the clinical area, percentage of faculty in full-time positions, NLN accreditation status
of the program, ratio of qualified applicants to admission slots, and number of graduates
taking the NCLEX-RN each year. The faculty/student ratio, percentage of faculty in
full-time positions, number of years of teaching experience of the faculty, and ratio of
qualified applicants to admission slots were indicators of positive NCLEX-RN out
comes. The percentage of faculty with a doctoral degree had a negative outcome on
state board examination results.
Valparaiso University’s College of Nursing had a pass rate on the NCLEX-RN
lower than the state average, and they were in danger of losing their accreditation. The
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NCLEX-RN results for the 5 years prior to 1997 indicated that transfer students were at
the greatest risk for failure of the exam. In a dissertation, Forsythe (1997) identified
predictors of success that would identify transfer students at risk for failure on the li
censure examination and developed an intervention program for the at-risk students.
Roye (1997) completed a dissertation in order to study NCLEX-RN failures in an ADN
program. Records of 194 graduates of a community college nursing program between
1992 and 1994 were reviewed. There were only 10 failures during that time. The vari
ables for the study were ACT scores, SAT scores, and cognate GPA. It was found that
those who passed the examination were older than those who failed, and the mean ACT
composite scores, SAT composite scores, and cognate GPA were all higher for those
who passed the examination than for those who failed.
Ryan (1997) studied 100 community college nursing graduates who graduated
between fall 1987 and spring 1992. The purpose of the study was to examine the effect
of mathematics and/or English matriculation and intervention in predicting three mea
sures of success on the NCLEX-RN for three groups of at-risk students. Study group 1
consisted of 52 graduates who were not required to matriculate for mathematics and
English. Study group 2 was 35 graduates who were required to matriculate for mathe
matics and English and who received follow-up services. Study group 3 was 25 gradu
ates who were required to matriculate but did not receive follow-up services. Data were
collected from student records to compare GPAs, scores on the Diagnostic Readiness
Test (DRT), and pass rates on the NCLEX-RN for the three groups. Statistics showed
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no significant differences in GPA among the three groups, significant differences in
DRT scores, and no significant differences in NCLEX-RN pass rates.
A dissertation was completed on critical thinking in nursing education. Hall
(1996) wanted to examine the critical thinking ability of senior baccalaureate nursing
students and to see whether any relationships existed between critical thinking ability,
age, gender, level of cognitive development, socioeconomic status, ACT score, college
GPA. and success on the NCLEX-RN. The California Critical Thinking Skills Test
(CCTST) was administered to analyze critical thinking skills. The cognitive develop
ment of the students was assessed by administration of the Learning Environment Pref
erences (LEP) inventory. One hundred five students volunteered for the study. The
CCTST revealed that, overall, the students did not possess adequate critical thinking
skills. Significant positive correlations were found among critical thinking, cognitive
development, financial status, ACT score, and GPA. A negative association was found
between age and critical thinking ability. The two variables significant in predicting
NCLEX-RN success were critical thinking ability and financial status.
Research comparing the two testing methods is summarized as follows (see ap
pendix E). In 1997, Russell and Haney published a paper on the electronic journal Edu
cation Policy Analysis Archives. The researchers studied the effects of middle school
students’ performance on both multiple-choice questions and written test questions ad
ministered via computer and those administered via paper-and-pencil. Two groups of
students were randomly selected from grades 6 to 8 at a middle school. The experimen
tal group had 50 students who took the examinations via computer, and the control
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group had 70 students who took the examinations via paper and pencil. The findings
showed that results on multiple-choice test questions did not differ significantly be
tween the two modes of administration. With the written test questions, the students
who took the test via computer were more successful than were those who were tested
with the paper-and-pencil form. The computer group had 67.5% who were adequate
versus 30.4% in the paper-and-pencil group. They wrote almost twice as much and
were more apt to organize their thoughts into paragraphs. Students accustomed to writ
ing on computer performed better than those who were not. The effect of using
multiple-choice computer tests was more significant for females than for males: how
ever, males did better on the computer writing test. The researchers suggested that, as
more and more students become familiar with computers, traditional paper-and-pencil
assessment may not measure their abilities accurately.
Vispoel (1998) published a study that focused on the effects of the mode of test
administration, (CAT) versus Self-Adaptive Test, and test anxiety. Self-Adaptive Test
is a modified form of CAT. The examinee and not the computer makes decisions re
garding the difficulty level of each item. Participants completed a test anxiety inventory
and then either a CAT or Self-Adaptive vocabulary test and a paper-and-pencil vocabu
lary test. The researchers reported that the Self-Adaptive students took more time than
the CAT students. The CAT students were found to be more precise because of the fact
that the CAT uses an algorithm to choose test items from a pool, which reduces mea
surement error over a test in which all test takers are given the same questions.
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The Educational Testing Services Network (ETS) is a nonprofit educational
testing and measurement organization. The company develops tests and administers
more than 11,000,000 tests worldwide. Each year, ETS funds research on testing. The
following are some of the research reports for 2000-2001 on studies involving tradi
tional paper-and-pencil tests versus computer tests.
Stocking, Smith, and Swanson (2000), in a project titled "An Investigation of
Approaches to Computerizing the GRE Subject Tests” explored the application of two
computer-based tests (CBT)—CAT and linear-on-the-fly testing (LOFT)—to two GRE
subject tests: the mathematics and biology tests. The study recommended that convert
ing the CBT seems viable if pretesting is implemented, item rating is expanded, test
length is reduced, classification schemes are improved, and the roles of test specialists
are revised.
Bridgeman and Cline (2000) explored the fairness of the CAT version of the
Graduate Record Examination (GRE) and released the report Variations in Mean Re
sponse Times for Questions on the Computer-Adaptive GRE General Test: Implica
tions for Fair Assessment. The researchers felt that questions with the same difficulty
level and roughly the same content area could vary in the amount of time required to
answer them. The study sought to explore whether the administration of a dispropor
tionate number of questions with long response times could present a disadvantage to
examinees. The study looked at the GRE quantitative measure and GRE analytical
measure and respective response times. For both tests, a substantial variation in re-
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sponse times was found; however, there was no evidence that students who received
items with long response times were disadvantaged.
Gallagher, Bridgeman, and Cahalan (2000) analyzed data from several national
testing programs to determine whether the change from paper-and-pencil tests to
computer-based tests influenced performance by various groups. Performance by race,
gender, and language variables on the GRE General Test, GMAT, SAT I Reasoning
Test. The Praxis Series: Professional Assessment for Beginning Teachers (PRAXIS),
and Test of English as a Foreign Language (TOEFL) was studied to see whether the
change in method of administration placed any of the groups at a disadvantage. African
American and Hispanic examinees appeared to benefit slightly from the CBT versions,
as they performed equally or better on the CBT than on the paper-and-pencil exams.
African American and Hispanic females did slightly better on the paper-and-pencil test
than on the CBT test; however, White females did slightly better on the CBT. The
computer-based TOEFL appeared to place Chinese and Korean groups at a disadvan
tage. Familiarity with computers did not significantly influence the study results.
Powers, Burstein, Chodorow, Fowles, and Kukich (2000) studied the validity of
automated/computer scores versus hand-scored complex examinations such as tests of
writing skills or tests that require the examinee to construct an answer instead of select
ing one from multiple response choices. The researchers analyzed two sets of GRE
Writing Assessment scores: those by human raters and those given by computer. The
"e-rater” system was used for the computer scoring of the exam. It uses natural
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language processing techniques to model human raters in grading essays. Results were
that the two rating methods yielded similar results.
Another study evaluated paper-and-pencil versus computer graded mathematics
tests (Gallagher, Bennett & Cahalan, 2000). The study participants took both a paper-
and-pencil and a computer-based mathematical expression test (which requires exam
inees to construct mathematical expressions). The findings indicated that some ex
aminees reported mechanical difficulties in responding on the CBT, and they indicated a
preference for the paper-and-pencil test.
Researchers must continue to evaluate the value of computer-based examina
tions. Overall, current studies have shown that computer-based tests are equal to tradi
tional paper-and-pencil tests in evaluating a candidate’s abilities. More research is
needed in this area to confirm the preliminary study results. Children are becoming
"computer literate” at a young age. Advances in education and technology may render
paper-and-pencil tests a thing of the past. The CAT version of the NCLEX-RN is no
different from other computer-based tests in that its validity and reliability must be
evaluated.
Before implementation of the CAT version of the NCLEX-RN, field-testing was
performed by the NCSBN to establish the feasibility of the computerized examination.
They studied the efficiency, measurement properties, and logistics of the CAT version.
From July 1990 to November 1992, field tests were conducted (NCSBN, 2002). The
psychometric analysis was completed to determine whether the pass/fail scores from the
paper-and-pencil version of the NCLEX-RN were comparable to those from the CAT
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version. The results of these studies revealed that candidate performance on the paper-
and-pencil version equaled that on the CAT version. The demographic groups utilized
for the studies were neither disadvantaged nor advantaged by the CAT version of the
exam. After the first 4 months of CAT testing, the NCSBN reviewed the pass rates and
compared them to those obtained on the paper-and-pencil version. It was reported that
the CAT pass rates were similar to the paper-and-pencil version pass rates: July 1993
paper-and-pencil was 91.1% pass, February 1994 paper-and-pencil was 89.9% pass,
April to June 1994 CAT was 93.3% pass. The NCSBN continued to monitor the pass
rates on the CAT version of the NCLEX-RN, and for the first year of administration the
pass rates for first-time test takers who were United States-educated was 90%. These
candidates took an average of 110.2 questions and the average test time was 1.95 hours
(NCSBN, 2002).
In addition to the studies that have been discussed on predictors for success on
the NCLEX-RN, there have also been studies on interventions to enhance performance
on the examination. Frierson et al. (1993) published a study assessing an intervention
for enhancing performance on the nursing licensure examination. The purpose of the
study was to assess the effects of a three-pronged intervention approach on NCLEX-RN
performance for 8 African American nursing students at a historically Black state-
supported university. The three interventions were (a) instructions in effective test
taking, (b) student participation in learning teams, and (c) follow-up activities that the
faculty conducted in order to reinforce the first two components. The 8 students began
participation in the program during their senior year. The goal of the program was for
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all 8 students to pass the examination with a score of 1600 or higher. All 8 students
passed the examination, with scores of 1653-2151. The pass rate of the school for the
period 1994-1998 was 65%; therefore, this 100% pass rate was significantly higher than
the school pass rate. This study showed that intervention can significantly improve
NCLEX-RN pass rates.
In summary, grades were found to be very good predictors of success on the
NCLEX-RN. Nursing school grades were especially helpful in identifying students at
risk for failure on the examination. Admission criteria such as ACT scores, high school
GPA, and SAT scores were also correlated with success on the licensure exam. Almost
all of the researchers stated that more research is needed in this area. Predictors for suc
cess are well established in the literature; however, more studies are needed regarding
what the best interventions for at-risk students.
There is much literature on predictors for success and preparing nursing gradu
ates for the paper-and-pencil version of the NCLEX-RN. Research is needed to estab
lish predictors for success on the CAT version of this nursing licensure examination.
Some of the predictors for the paper-and-pencil NCLEX-RN may prove to be the same
for the CAT version; however, studies are needed to validate which ones apply to the
CAT exam and which ones do not apply. It would be important for researchers to repli
cate some of the studies done on the paper-and-pencil exam and apply them to the CAT
version. In addition to replication of previously completed studies, researchers must
perform studies to identify predictors not used as variables in the previous studies. Ex
amples would be variables such as previous computer experience of the test candidate,
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computer programs required in the nursing program, and method of test preparation
(such as CD-ROM preparation programs). Nursing faculty can begin by utilizing the
previously established predictors for success on the paper-and pencil NCLEX-RN and
identify students in need of intervention; however, the list of predictors must be ex
panded for the CAT version of the exam.
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CHAPTER 3
RESEARCH METHODOLOGY
This chapter contains the methodology of the study. The objective of the study
was to answer the following research question: How can nursing school faculty prepare
graduates for the computerized version of the licensure examination? Audits of student
files, focus groups, and interviews were conducted utilizing a community college ADN
program in the western United States.
Research Population
The research population for the study was comprised of students enrolled in
community college ADN programs. According to the NCSBN (2002), 55-59% of the
candidates taking the NCLEX-RN are from ADN programs. The mean age of ADN
NCLEX-RN candidates is 31 years, with a standard deviation of 8 years. The ADN
programs have prerequisite courses (such as anatomy, physiology, and microbiology)
that must be completed prior to entering the ADN program or within the first year of
entering the program. Therefore, at least 50% of these students have completed college
courses before beginning the nursing curriculum. The research sample for this study
included graduates, faculty, administrators, and members of the advisory committee of a
community college ADN program in the western United States. The college had a total
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enrollment of approximately 23,000 students. The ADN program of this college gradu
ates approximately 40-60 students each spring and fall semester. There were approxi
mately 160-220 students in the program at the time of the study.
Research Design
The study included both quantitative and qualitative segments. Demographic
data for the qualitative part of the study were collected from the student files of program
graduates, which are maintained by the ADN program director. The student files con
tained the following information: an application with demographic data, prerequisite
and/or corequisite courses completed (with the earned grades), graduation transcripts,
and evaluations from each clinical course. The sample of the study included graduates
from both the spring and fall semesters from May 1994 through May 2000.
The files of all 590 program graduates during this period were collected. The
NCLEX-RN results were reported as pass or fail. The list of NCLEX-RN results for the
program provided to the program director by the BRN was used to separate the first
time failures (40) from the graduates who passed the examination on the first attempt
(550). The files of all 40 graduates who failed the examination on the first attempt were
used for the sample. Files of graduates who passed the examination on the first attempt
were selected for inclusion in the study by taking every third file from the spring and fall
semesters from May 1994 through May 2000 until 10 who had passed on their first at
tempt were selected from each semester (total of 130 files). The following data were
collected from the files: gender, age, ethnicity, cumulative nursing course GPA, type of
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student (generic, LVN-to-RN, transfer), English course taken (English I or English
105), and prerequisite and/or corequisite courses taken prior to entering the program
(see Tables I and 2).
After the data were collected, frequencies were run, tables were designed, and
multivariate analyses were performed. The group who passed the examination on the
initial attempt and the group who did not pass were analyzed to determine differences in
gender, age, ethnicity, cumulative nursing course GPA, type of student, English course
taken, number of prerequisite and/or corequisite courses, and number of biology courses
completed before entering the program.
To enrich the quantitative data and to better understand the true differences be
tween the two groups, qualitative data were also collected via focus groups and one-on-
one interviews. One of the important goals of the qualitative segment was to gain
suggestions about how to prepare graduates for the CAT version of the NCLEX-RN.
Four separate focus groups were conducted. The groups enabled the researcher to col
lect data on the preparation of nursing school graduates for success on the licensure ex
amination.
Focus Group One included 30 program graduates from May 1994 through May
2000 who had passed licensure exam on the initial attempt. A letter was sent to the last
known place of employment and telephone calls were made to 87 program graduates
who had passed the exam on the initial attempt, inviting them to participate in a focus
group. These graduates were selected based on the fact that their place of employment
was known and/or classmates provided a telephone number for the graduate. To
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Table 1
Prerequsite Courses
Course Description
Transfers to
university
Biology 60 Combines anatomy, physiology, microbiol
ogy, nutrition, and elementary chemistry
Yes
Biology 60 Lab A practical lab providing practical experi
ence in anatomy, physiology, and microbi
ology
Yes
Child Develop
ment 47
A study of emotional, intellectual, and
physical growth patterns from conception
to death
Yes
English 1
or
Expository and persuasive writing based on
college-level reading, research and critical
thinking
Yes
English 105 The study and performance of writing to en
able the student to express ideas clearly in
essay form, using standard written English
No—meets the re
quirements for an
Associate Degree
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Table 2
Co-requisite Courses
Course Description
Transfers to
university
Biology 6 1 Introduction into the study of disease, including cause,
prevention, and symptoms of common human diseases,
as well as normal anatomy and physiology
Yes
Biology 62 Advanced anatomy, physiology and microbiology
which includes the nervous system, sense organs, the
circulatory, respiratory, excretory and digestive sys
tems, common infectious diseases and epidemiology
Yes
Humanities A choice of courses such as world culture or philosophy Yes
Psychology 1 Introduction to human psychology and behavior Yes
Speech 10
or
Theory and practice in the construction and delivery of
the extemporaneous speech
Yes
Speech 20
or
An experimental approach to the study of the process of
communication at both the intrapersonai and interper
sonal levels
Yes
Speech 30 The theory and practice of basic principles and tech
niques of both small group and public group communi
cation
Yes
Sociology I Study of human behavior through an understanding of
social organization
Yes
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facilitate discussion and encourage participation, the participants were asked to select
one of three meeting times that was convenient for them. Focus Group Two included
representatives of school administrators: the Dean of Health and Science, the ADN
Program Director/ Department Head, and the four lead teachers from each course in the
program. Focus Group Three included four available members of the ADN faculty. Fo
cus Group Four included five available members of the program Advisory Committee,
which is composed of representatives from local health care organizations.
Each focus group met in a conference room at the school of nursing or at a local
hospital in November and December 2001. Each meeting session lasted approximately
60 minutes. At the beginning of each group meeting, the researcher briefly introduced
the topic of the study and the research question. After the introduction, the group was
asked open-ended questions that were based on the literature comparing paper-and-
pencil testing and computerized-adaptive testing (Bridgeman & Cline, 2000: Russell &
Haney, 1997; Vispoel, 1998). The first focus group was asked the following questions:
1. How did you feel about taking an examination on computer?
2. What were differences that you noted in taking an examination on the com
puter versus taking a paper-and-pencil examination?
3. How did you prepare for the examination?
4. What do you feel helped you on the examination?
5. What did not help you on the examination?
6. What in your nursing program assisted you in preparing for the examina
tion?
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7. What in your nursing program did not assist you in preparing for the exami
nation?
Both the second and third groups were asked the following questions:
1. What in the curriculum do you feel assists students in preparing for the
examination?
2. What in the curriculum does not assist them on the examination?
3. What changes have been made to the curriculum since the start of the CAT
version of the examination to assist students in being successful on the initial attempt of
examination?
4. What else could be changed in the curriculum to further assist students to be
successful?
5. What are the future plans to change the curriculum to assist students to pre
pare for the CAT version of the examination?
The fourth group was asked the following questions:
1. Are you observing a difference in the pass rates of the graduates whom you
have hired since the inception of the CAT version of the NCLEX-RN?
2. What suggestions do you have for the program to prepare students to be
successful on the examination?
Focus groups were selected as the method for data collection in order to gather
information from groups who are important to the preparation of ADN program stu
dents to be successful on the CAT version of the NCLEX-RN. The program graduates
(first group) provided information from the perspective of having actually completed
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the program and passed the examination. The administrators (second group) looked at
the topic from the perspective of those directing the nursing program. Faculty teaching
in the program (third group) have the responsibility to assist students to complete the
curriculum successfully and to pass the licensure examination. Members of the Advi
sory Committee (fourth group) were able to provide information from the perspective of
being associated with new graduates of the program. By utilizing different data sources
for the study (the various members of each focus group), triangulation was added to the
study. Triangulation assisted in adding validity and eliminating study biases.
During each focus group session, the researcher collected data by note taking
and tape recording the discussion. Following the meeting, the written notes and tape
recordings were transcribed. After the information had been transcribed, the data were
analyzed for themes. The themes are presented with actual quotes from study partici
pants to illustrate each theme.
In order to promote privacy and prevent embarrassment, individual interviews
were the chosen method of data collection for the program graduates who had not been
successful on their initial attempt to pass the NCLEX-RN. Since there was a total of 40
graduates between May 1994 and May 2000 who did not pass the examination on the
initial attempt, they were all used for the study. The following methods were used to
contact those graduates:
1. A letter was sent to the last known place of employment;
2. Telephone calls were made to former employers;
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3. Classmates were asked whether they had any contacts with other members of
their class;
4. Telephone calls were made to the last known number that the college had for
the graduate; and
5. Letters were sent to the last known address that the college had for the grad
uate.
The California BRN was contacted. According to the BRN representative, the
Board is not able to give out telephone numbers or addresses for any candidate who has
taken the NCLEX-RN.
Fourteen of the 40 graduates who did not pass the examination on the first at
tempt were contacted and participated in individual interviews. Some interviews were
conducted face-to-face, while others took place over the telephone or via mail. The re
searcher had to comply with the interview mode most convenient for each participant.
The interviews were designed to elicit feedback regarding failure on the initial attempt
of the examination. The questions asked were the same as those asked of the first focus
group. In addition, these interviewees were asked: Why do you feel you were not suc
cessful on the first attempt? What did you do differently to prepare for the following
attempt(s) at the examination? Data analysis for the interviews was the same as de
scribed for the focus groups. Face-to-face and telephone interviews were transcribed by
the researcher for data analysis, while the written mailed responses were read. All
participants were asked the same questions.
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Instrumentation
Quantitative data were collected on an instrument developed by the researcher.
The variables on the tool were selected based on the literature review (Alexander &
Brophy, 1997; Arathuzik & Aber, 1998; Barkley et al., 1998; Briscoe & Anema, 1999;
Endres, 1997; Felts, 1986; Foti & DeYoung, 1991; Fowles, 1992; Huepel, 1994; Jenks
et al., 1989; Rami, 1992; Woodham & Taube, 1986). The tool assured that the same
data were collected from each student file. Qualitative data were collected by note
taking and use of a tape recorder.
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CHAPTER 4
FINDINGS
This chapter provides the results of the study. A brief description of the method
ology for the quantitative data segment of the study is presented, followed by the meth
odology for the qualitative segment.
Quantitative Data
Quantitative data were obtained by reviewing the files of ADN graduates from
May 1994 through May 2000. During those years there was a total of 590 graduates;
550 passed the NCLEX-RN on the first attempt (93%) and 40 did not pass on the first
attempt (7%). The national pass rate for ADN graduates on the NCLEX-RN in 2000
was 83.8% (NCSBN, 2002). The community college utilized for the study had a pass
rate of 91-100% for 1989-1993. The files of all 590 program graduates May 1994
through May 2000 were collected. The list of NCLEX-RN results for the program pro
vided to the program director by the BRN was used to separate the first-time failures
(40) from the graduates who had passed the examination on the first attempt (550). The
files of all 40 graduates who had failed the examination on the first attempt were used
for the sample. The files of graduates who passed the examination on the first attempt
were selected for inclusion in the study by taking every third file from the spring and fall
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semesters from May 1994 through May 2000 until 10 who passed on their first attempt
were selected from each semester (total 130). The following data were collected from
the files: gender, age, ethnicity, cumulative nursing course GPA, type of student (ge
neric, LVN-to-RN, or transfer), English course taken (English I or English 105), and
prerequisite/corequisite courses taken prior to entering the program. The following are
the statistics from the graduate files.
Table 3 shows the demographic attributes of the subjects. The majority of the
subjects were female, about half were Caucasian, and the majority had gone to high
school in the United States. Two thirds were age 30 or under when they graduated. Pre
requisites were examined in three ways: total number of courses, number of biology
courses, and which of two English classes was taken. The nursing students have a
choice of taking English I or English 105. As defined in the college catalogue of the
community college related to this study, English 1 is expository and persuasive writing
based on college-level reading, research, and critical thinking. English 105 is the study
of performance of writing to enable the student to express ideas clearly in essay form,
using standard written English. English I transfers to the university system but English
105 meets the requirement for an Associate degree and prepares the student for English
1.
Table 4 shows the percentages and numbers of graduates that took each of these
prerequisites. As indicated in the table, the number of prerequisite/corequisite courses
taken before entering the nursing program ranged from 5 to 10, and the number of
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Table 3
Demographic Attributes o f Subjects
Attribute Category % n
Gender Female 83.5 142
Male 16.5 28
Ethnicity African American 6.5 11
Asian 21.2 36
Caucasian 49.4 84
Hispanic 20.0 34
Other 0.6 I
Not available 2.4 4
High school location United States 87.1 148
Foreign 3.5 6
Both 0.6 1
Unknown 8.8 15
Age at graduation 20-25 years 37.1 63
26-30 years 31.2 53
31-35 years 15.3 26
36-40 years 7.6 13
41-45 years 3.5 6
46-50 years 3.5 6
51-55 years 0.6 1
Not available 1.2
2
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Table 4
Prerequisite Courses Taken by Subjects
Prerequisite
Number or
category % n M SD
Total courses 5-6 2.4 4 9.28 1.07
7-8 14.1 24
9-10 82.9 141
Unknown 0.6 I
Biology courses
2
10.0 17 3.60 0.67
19.4 33
4 70.0 119
Unknown 0.6 1
English course Course #1 37.6 64
Course #105 36.5 62
At another college 25.9 44
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biology courses taken before entering the program ranged from 2 to 4. Of the subjects
who took one of these two English courses, about half took each.
The general educational background of the subjects was also examined. When
files were reviewed, it was noted whether the student had any previous college work,
had a previous college degree, and the student’s category (generic, transfer, or LVN-to-
RN). These data are shown in Table 5. As indicated in the table, about half of the grad
uates had taken courses at other colleges and/or universities prior to the courses taken at
the college where the nursing program is located, but only about 14% already had a
college degree. Eighty-six percent of the subjects were generic students, with nearly all
of the rest being LVN-to-RN students. Students varied in the quality of their academic
work while in the program. Cumulative GPA in the nursing courses ranged from 2.00
(C) to 3.88 (A), with a mean of 2.64 (C+) and a standard deviation of 0.43.
The time elapsed between graduation and first taking the NCLEX-RN was cal
culated. These results are shown in Table 6. One graduate took the examination after
completing the program but prior to graduation. About two thirds took the NCLEX-RN
for the first time within 3 months of graduation. Only about 10% waited 5 months or
more after graduation to take the examination for the first time. One student waited 1
year, and another waited nearly 2 years. With the student who waited nearly 2 years
removed, the mean was 2.76 months and the standard deviation to 1.73 months.
Because there was a large number of missing data points, mainly because there
were so many transfer students, predictor variables were first examined individually
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Table 5
General Educational Background o f Subjects
Prerequisite Category % n
Previous college courses Yes, in United States 44.7 76
Yes, outside United States 4.1 7
None 45.3 77
Unknown 5.9 10
Previous college degree Yes 13.5 23
No 76.5 130
Unknown 10.0 17
Type of student Generic 85.9 146
Transfer 1.8 3
LVN-to-RN 11.8 20
LVN-to-RN transfer 0.6 1
Mote. LVN = Licensed Vocational Nurse; RN = Registered Nurse.
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Table 6
Elapsed Time Between Graduation and NCLEX-RN
Elapsed months % n M SD
- 0.2-0.9 8.2 14
1.0-I.9 28.8 49
2.0-2.9 28.8 49
3.0-3.9 16.5 28
4.0-4.9 5.9 10
5.0-6.9 7.1 12
7.0-8.9 2.9 5
12.2 0.6 1
21.7 0.6 1
Unknown 0.6 1
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rather than immediately put into a multivariate analysis. This prevented the loss of a
large percentage of the subjects in the multivariate analysis.
First, the basic demographics were compared with the outcome variable of
pass/fail. For gender, ethnicity, and high school location, Fisher’s Exact test was used
for the 2x2 tables and chi-square analysis was used for larger tables. These results are
shown in Table 7. As shown in Table 7, neither gender nor location of high school was
significantly related to whether the graduate passed the NCLEX-RN on the first attempt.
However, ethnicity was highly significant: Those who failed the examination on their
first attempt were 10.7% (9) of the Caucasians, 30.6% (11) of the Asians, 35.3% (12) of
the Hispanics, and 63.6% (7) of the African Americans.
Age was compared with pass/fail by means of a two-tailed t test, the results of
which are shown in Table 8. Table 8 shows that age at graduation was not significantly
related to whether a subject passed or failed the NCLEX-RN on the first attempt.
Next, the prerequisite courses were compared with pass/fail. Table 9 shows the results
of t tests for the total number of prerequisites taken and the number of biology prerequi
sites taken. Table 9 shows that neither the total number of prerequisites taken nor the
number of biology prerequisites taken had a significant relationship with NCLEX-RN
outcome. One-tailed probabilities would not be significant either, as they were .315 and
.485, respectively.
A Fisher’s Exact test was used to compare which English class (1 or 105) was
taken versus the examination outcome. The two-tailed probability result was .016. For
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Table 7
Chi-Square and Fisher’ s Exact for Demographics Versus Pass/Fail
Demographic Chi-square
d f P
Gender 1.000
Ethnicity1 21.04 3 < .001
High school location1 3 1.000
T he one "other” subject was eliminated, leaving just the four larger eth
nic groups included. T he one "both U.S. and foreign” subject was elim
inated, leaving two subject groups: U.S. and foreign.
Table 8
Age at Graduation Versus Pass/Fail on First Attempt: t Test
NCLEX-RN
outcome n M SD t
d f
P
Pass 128 2.28 1.43 1.30 83 .196
Fail 40 2.00 1.11
Note. NCLEX-RN = National Council Licensure Examination for Registered Nurses.
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Table 9
Total and Biology Prerequisites Versus Pass/Fail on First Attempt on NCLEX-RN: t
Test
Prerequisites
taken
NCLEX-RN
outcome n M SD r
d f P
Total Pass 129 9.26 1.10 -0.483 167 .630
Fail 40 9.35 1.00
Biology Pass 219 3.60 0.64 -0.038 167 .969
Fail 40 3.60 0.74
Note. NCLEX-RN = National Council Licensure Examination for Registered Nurses.
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those who took English 1,82.8% passed the examination on the first attempt, and for
those who took English 105 the figure was 62.9%.
The three variables covering general educational background, previous college
courses, previous college degree, and type of student were compared with the NCLEX-
RN outcome by means of Fisher’s Exact (for 2x2 tables) or chi-square tests (for larger
tables). These results are shown in Table 10. Neither previous college courses—in the
United States, at foreign college, or no courses—nor having a previous college degree
was significantly related to NCLEX-RN outcome. Type of student (generic, transfer, or
LVN-to-RN) was not significantly related either, but there was a trend. All 3 transfer
students passed the NCLEX-RN on their first attempt, as did 78.8% of the generic
category and 60.0% of the LVN-to-RN students. With the 3 transfer students excluded,
Fisher’s Exact probability was 1.00, still not significant.
GPA in the four main nursing courses was compared with NCLEX-RN outcome
by means of a t test. The results are shown in Table 11. Table 11 shows a highly signif
icant relationship between GPA and examination outcome, with those who passed the
examination on the first attempt having a mean grade of B- and those who failed on the
first attempt averaging a C+.
The final variable compared with examination outcome was months elapsed
between graduation and first attempting the NCLEX-RN. As shown in Table 6, there
was an outlier in this variable; one subject waited nearly 2 years to take the exam.
Because t tests are very sensitive to outliers, this subject’s elapsed time was recoded to
12.2 months, the same as the second longest subject. These results are shown in Table
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Table 10
Chi-Square and Fisher's Exact for General Educational Background
Versus Pass/Fail
Background measure Chi-square
df
P
Previous college courses 0.51
2
.777
Previous college degree 1.000
Type of student1 1 4.41
2
.110
The one “Transfer and LVN-to-RN” subject was eliminated leaving just
the three main response categories.
Table 11
Grade Point Average in Nursing Courses Versus Pass/Fail on First Attempt on
NCLEX-RN
NCLEX-RN
outcome n M SD t
d f
P
Pass 130 2.74 0.42 7.54 102 <.001
Fail 40 2.32 0.27
Note. NCLEX-RN = National Council Licensure Examination for Registered Nurses;
GPA = grade point average.
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12. Table 12 shows that, with a one-sided hypothesis, elapsed time is significant, p -
.027. The longer the elapsed time, the more likely the graduate was to fail. Had the
outlier not been recoded, /(43) = -1.72, one-tailed probability was .046, also significant.
The final step in the quantitative analysis was to select just those variables that were
significant in their bivariate relationship with NCLEX-RN outcome and perform a
multivariate analysis. There were four such predictor variables: ethnicity, which Eng
lish class, GPA, and elapsed months before taking the examination. A logistic regres
sion was performed with NCLEX-RN outcome as the dependent variable and GPA in
the four nursing classes and elapsed time between graduation and taking the exam as
predictors. (For the elapsed month variable, again, the single outlier was recoded from
22 months to 12 months.) Two categorical predictors were also included: ethnicity and
which of the two English classes was taken. Subjects with missing data on any of the
four predictor variables were dropped from the analysis. For this analysis, categorical
variables must be recoded to dummy variables, and to one fewer group than the number
of categories in the data. Since Caucasians were the largest ethnic category, they were
used as the referent group. Hence, subjects in the three other ethnic groups were com
pared with them. The results of this logistic regression are shown in Table 13.
Table 13 shows that GPA in the four nursing classes was by far the best predic
tor of whether a graduate passed or failed the NCLEX-RN on the first attempt: Those
with higher grades were more likely to pass. Overall, there was a trend between ethnic
ity and examination outcome. The relationships between both African Americans and
Hispanics with examination outcome were significant, with the students from both
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Table 12
Time (Elapsed Months) Between Graduation and Taking the NCLEX-RN Versus Pass/
Fail on First Attempt: tTest
NCLEX-RN
outcome n M SD t d f p
Pass 130 2.63 1.67 -1.97 50 .054
Fail 40 3.42 2.34
Note. NCLEX-RN = National Council Licensure Examination for Registered Nurses.
Table 13
Multivariate Logistic Regression to Predict NCLEX-RN Outcome
Predictor Wald
d f P
GPA for four nursing classes 13.995 1 <.001
Elapsed months before taking exam 1.746 1 .186
Ethnicity*, overall 6.409 3 .093
African American (versus Caucasian) 4.107 1 .043
Asian (versus Caucasian) 0.340 1 .560
Hispanic (versus Caucasian) 3.931 I .047
English 1 (versus English 105) 2.585 1 .108
Note. NCLEX-RN = National Council Licensure Examination for Registered Nurses;
GPA = grade point average.
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ethnic backgrounds significantly less likely than Caucasians to pass the NCLEX-RN on
their first attempt. There was also a trend between a higher pass rate and having taken
English I instead of English 105. There was no relationship between elapsed months
before taking the examination and the examination outcome.
Twenty-eight percent of the cases had missing data on at least one of the four
predictor variables, so only 122 of the 170 cases were included in the above logistic
regression. This is of particular concern because these were not a random 28% of the
cases; they were mostly transfer students, thus biasing the study sample. Therefore, it
was important to determine the relationship between the predictor variables and exami
nation outcome with more of the study’s subjects. Since the majority of the missing
data were in the English class variable, and that variable was not a significant predictor
of NCLEX-RN outcome, the analysis was repeated without the English class variable.
The results of this analysis, with 164 of the 170 subjects, are shown in Table 14.
As shown in Table 14, when English class was removed as a predictor, allowing
an additional 42 subjects to be included in the analysis, GPA was still highly significant
and the best predictor of examination outcome. Overall ethnicity was now statistically
significant, with African Americans and Hispanics showing significantly lower passing
rates than Caucasians. Elapsed time between graduation and taking the NCLEX-RN
exam was not a predictor of exam outcome.
To summarize, this section first reported the demographic attributes of the sub
jects. They were 84% female, half Caucasian, and nearly 70% age 30 or younger at
graduation. Second, these demographics, along with measures about the subjects’
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Table 14
Multivariate Logistic Regression to Predict NCLEX-RN Outcome, With English Class
Omitted
Predictor Wald
d f
P
GPA for four nursing classes 19.621 1 <.001
Elapsed months before taking exam 0.676 1 .411
Ethnicity: overall 9.911 3 .019
African American (versus Caucasian) 8.279 1 .004
Asian (versus Caucasian) 1.936 1 .164
Hispanic (versus Caucasian) 4.547 1 .033
Note. NCLEX-RN = National Council Licensure Examination for Registered Nurses;
GPA = grade point average.
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academic backgrounds (where they went to high school, previous college experience,
numbers of prerequisites, courses taken, nursing GP As, and the elapsed time between
graduation and first taking the NCLEX-RN) were individually compared with exam
outcome. This step was taken because there considerable data were missing, largely due
to transfer students, and thus a multivariate analysis with all 12 predictor variables
would have contained few subjects. These bivariate analyses pointed to four predictor
variables that merited additional attention: GPA, elapsed time before taking the exami
nation, which English course was taken, and ethnicity of the graduate.
The third step was a series of two multivariate logistic regression analyses with
these predictor variables. The results showed that GPA in the four nursing classes was
by far the best predictor of NCLEX-RN examination outcome. Also, African American
and Hispanic graduates had significantly lower first-time pass rates than did Caucasian
graduates. Finally, there may be a trend between which English class was taken and
first-time examination outcome.
Qualitative Data
Qualitative data were obtained through focus group interviews of (a) graduates
who passed the NCLEX-RN on the initial attempt, (b) program administration mem
bers, (c) program faculty, and (d) program advisory committee members. Individual
interviews of graduates who did not pass the NCLEX-RN on the initial attempt were
conducted face-to-face, over the telephone, or by mail. All of the focus group and indi
vidual interviews were conducted by the researcher. Data were collected via note
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taking, tape recording, and written responses. The data were transcribed by the re
searcher and themes were recorded. Themes were selected for data analysis because of
their importance to qualitative research: “The concept of theme is critical to the accu
rate interpretation of qualitative data” (DeSantis & Ugarriza, 2000, p. 351). LaPier and
Scherer (2001) also spoke about the importance of themes in qualitative research. After
all of the data were transcribed, the researcher read the findings and grouped similar
comments from the focus groups and individual interviews as themes. Byrne (2001)
described how qualitative data originate from transcript or observation notes and are
“pared down to represent major themes or categories” (p. 904).
Focus Group One, ADN program graduates who passed the NCLEX-RN on the
initial attempt (successful graduates) was composed of 31 ADN program graduates.
Focus Group Two, ADN Program Administrators, was composed of the following six
members of the ADN program administration: the Dean of Health and Science, the
ADN Program Director, and the four lead instructors from each nursing semester.
Focus Group Three, ADN Program Faculty, was composed of four available members
of the ADN program faculty. Focus Group Four, ADN Program Advisory Committee,
was composed of five nursing educators from local hospitals used for clinical experi
ence. Interviews were also conducted with 14 ADN program graduates who did not
pass the NCLEX-RN on the initial attempt (unsuccessful graduates).
Listed below are the themes that emerged when the successful and unsuccessful
graduates were asked to share their thoughts on taking the computer version of the test:
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1. Those with more experience in using a computer reported less anxiety while
taking the examination on the computer than those with less computer experience. "I
am used to the computer, so it was not bad for me. It was hard for some other people in
my class that were not used to the computer” (successful graduate). “I didn’t have much
computer experience so it was difficult for me” (successful graduate). "'Computer skills
take practice and I needed more practice time” (unsuccessful graduate).
2. Some liked the interaction that occurred when taking the examination on the
computer versus taking a paper-and-pencil test. " ‘I really liked the interaction on the
computer. The hands-on with the computer helped me to feel more comfortable during
the test” (successful graduate).
3. Participants in the focus groups and individual interviews expressed that
testing on a computer was very different from the paper-and-pencil tests administered in
the nursing program. "'It was so different from the tests in school. It was not like them
at all” (successful graduate). Some of the differences reported were the following:
a. On the computer, they were not able to skip questions and return to them
later.
b. On the computer, they were not able to go back and change answers.
""The computer was really different from the tests in school. I could not skip questions
and go back to them later or go back and change my answers” (successful graduate). " " I
sat down to a computerized test and I really missed the kinesthetic aspect of picking up a
piece of paper and handling it and being able to go back to what I had done” (advisory
committee member).
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c. On the paper-and-pencil tests, they were able to write notes on the test
itself.
The graduates provided the following comments about how they prepared for
the examination, what helped them on the examination, and what study aids they found
most helpful:
1. The preparation method that the majority of the successful graduates used
was the range of commercially prepared computer review NCLEX-RN programs. ”1
went to the learning center at school and used the computer programs there” (successful
graduate). "The tools in the learning center helped with the pathophysiology” (success
ful graduate). "The computer programs were the best and helped me the most. They
were much better than the books” (successful graduate).
2. The graduates studied utilizing NCLEX-RN review books by Kaplan, Mos-
by, and Lippincott. "I studied the review books daily, I just continued answering ques
tion after question out of the review books” (unsuccessful graduate). “A friend and I got
together and we would quiz each other from the books and that is all that I did to study”
(successful graduate).
3. The graduates reviewed areas in which they felt weak or in which they
scored poorly when taking the practice tests in the books or on computer. “I would go
back and review my notes for the things that 1 did bad on” (successful graduate). "As I
was studying, if I felt unsure of an area, I would review my textbook or my school
notes” (successful graduate).
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4. The graduates verbalized that it would benefit future graduates to take the
examination as soon as possible after graduation. “I would really encourage other grad
uates to take the exam as soon as possible after graduation” (successful graduate). ”1
waited a few months after graduation to take the exam and I don’t think that was good.
It would have been better to take it as soon as possible” (successful graduate). “I waited
too long and I failed” (unsuccessful graduate).
5. The Kaplan course was reported by the graduates to be very helpful, espe
cially with test-taking skills such as selecting the best answer. “I thought that the Kap
lan course was great. It helped me know what areas to focus on when I studied” (unsuc
cessful graduate).
6. The graduates reviewed class notes from the program. "I mostly reviewed
my class notes from each course of the program. I especially looked at notes from the
first year of the program” (unsuccessful graduate).
The following are comments about what did not help the graduates on the
examination. Overall, both groups of graduates felt that the program prepared them
well for the examination and had no other comments. "It was a great program and does
a good job” (successful graduate). “The instructors do a wonderful job, it is a very good
program” (successful graduate). “Some teachers were too hard in clinical” (unsuccess
ful graduate). Some of the successful and unsuccessful graduates felt that the review
books did not help them prepare for the examination. “The books really didn’t help
much. Working on the computer helped a lot more” (successful graduate).
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The following are comments from all of the focus groups and the interviews
regarding what in the ADN program prepared graduates for the exam:
1. The results of the NLN exams that were taken in the second semester medi
cal/surgical nursing course, third semester women’s health nursing course, third semes
ter mental health nursing course, fourth semester pediatric nursing course, and fourth
semester leadership course all were helpful. These results helped to designate areas of
weakness for the graduates to study more during their preparation. The most helpful in
preparing for the computerized NCLEX-RN was the comprehensive NLN taken in the
fourth semester leadership course. “Those NLN tests really helped me know what to
study. I went back and reviewed areas that I did poorly on in the NLN tests” (successful
graduate). “The NLN test in leadership really helped me to focus my studying. It also
gave me confidence that I knew more than I thought I did” (successful graduate). “I did
poorly on the NLN test, especially the comprehensive test in fourth semester, and I did
not take my score seriously” (unsuccessful graduate).
2. The fact that all tests during the nursing program were timed at 1 minute per
question helped them to pace themselves on the NCLEX-RN. “It was good that the tests
in the program were timed. Pacing myself on the exam was easy because I had to do it
in school” (successful graduate). “We need to look at the information that has been
gathered on timing our exams and come up with an average time per question” (faculty
member).
3. Computerized tests had been administered in the mental health, pediatrics,
and leadership courses. “We are giving computer tests in some courses” (faculty
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member). "The ATI [American Testing International] computerized exams that we are
giving help them to become more computer oriented” (administrator).
4. Almost every course had at least one CD-ROM computer program as a re
quirement. “Almost all of the courses had CD-ROMs that help to familiarize the stu
dents with the computer and help with critical thinking” (administrator).
5. The second semester medical/surgical nursing (12 A and 12B) and mental
health nursing (21B) courses gave weekly quizzes. “We gave weekly quizzes because
of the large amount of information and found that the students were more prepared be
cause they had to study on a consistent basis” (administrator). “Other courses continued
to give quizzes every other week” (faculty member).
6. Grants were explored to obtain funding for more computer testing programs.
“We are writing a grant to get funding for a computerized test package for the students”
(faculty member). “We are writing a grant to be able to administer some quizzes or sub-
modules on computer” (administrator).
7. The library offered Internet computer access to students. “Students can go to
the library and have Internet and computer access and that allows the students to be
come used to the computer” (faculty member). “Appointments can be made at the li
brary so the students can have immediate access to the computers” (faculty member).
"Students should take advantage of the classes offered by the library on computer use
and test taking skills. We need to find out about the times these classes are offered to
see if they are compatible with our students’ schedules” (administrator).
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8. The use of a mental health textbook that included a CD-ROM program with
student activities that encouraged critical thinking was reported to be helpful. "The
fourth edition of our psychiatric nursing book comes with a CD-ROM that has all
critical thinking exercises. Maybe we should look at other textbooks with CD-ROM
programs to give the students practice with the computer and critical thinking” (admin
istrator). "We should have at least one CD-ROM program required in each course”
(faculty member).
9. The program requirement of a computer class as a prerequisite assists the
graduates with basic computer knowledge and helps them to become familiar with com
puters. "We require a computer class that helps them with basic computer knowledge”
(administrator). "The computer class that we had to take helped me to feel more com
fortable with the computer” (successful graduate).
10. There were computers in the learning center for the students. Those com
puters were used for computer review programs for the NCLEX-RN and computerized
testing of the students. "There are computers in the learning center for the students to
use for practice for the NCLEX” (administrator).
11. The last semester of the program (pediatrics, intensive care, and leadership)
helped to bring together for the graduates all that had been learned in the program. "The
last semester helped me a lot. It helped me bring everything together for the test” (suc
cessful graduate). "Leadership is too hard and too much is expected of us in clinical”
(unsuccessful graduate).
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The following are the comments regarding what in the program did not help
prepare graduates for the examination:
1. The format of the test questions in the program was different from that used
in the NCLEX-RN. Most of the test questions during the program had one or two cor
rect answers, whereas those in the NCLEX-RN had four correct answers, with one being
the best answer. "The test questions in the program were not like the RN exam” (suc
cessful graduate). "They need to be able to prioritize the best answer and a lot of our
quizzes need to be changed to require more thought in the answers” (administrator).
"We are revising our test banks to more accurately fit the format of the state board tests”
(faculty member).
2. The NLN exams did not help the graduates to prepare for the NCLEX-RN.
"Those NLN tests didn't help much” (successful graduate).
3. For some classes the theory component was hard but clinical was easy. "For
some classes, like mental health, the theory was hard but the clinical was too easy” (un
successful graduate).
The following were suggestions made by the groups for additions to or improve
ment of the ADN program in order to assist program graduates in preparing for the
exam:
1. Require computer classes before they begin the program. "I think that they
should take the computer class earlier” (successful graduate).
2. Administer as many tests via computer as possible. "If faculty could have
anything that you want, I would think that it would be obvious that each of your exams
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be put on computer. That would get them in the habit of studying for a computer exam”
(advisory committee member).
3. Encourage and direct more critical thinking and prioritizing exercises (dis
cussion of case studies and scenarios during lecture and campus lab). “You should do
more case studies, critical thinking and prioritizing in lab” (successful graduate).
4. Offer course-required self-learning modules on computer. “Maybe put the
self-learning modules on computer” (successful graduate).
5. Decrease the amount of lecture and utilize that time for participation and
discussion. “We need to not do as much lecturing but more participation and discus
sion” (administrator).
6. Hold the students accountable for class preparation. “We must hold the
students accountable for lecture” (administrator). “The students need to come to lecture
prepared so that we can have more discussion and critical thinking exercises” (adminis
trator).
7. Adapt teaching methods to our changing student population. “Our teaching
methods need to be changed to adapt to our changing student population” (faculty
member).
8. Offer tutoring to familiarize students with the computer. “Maybe we could
offer computer tutoring” (faculty member).
9. Have the availability of online office hours. “Faculty should offer online
office hours” (faculty member). “Faculty could do at least one of their 5 weekly office
hours online” (administrator).
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10. Encourage graduates to take the licensure examination soon after gradua
tion. "Have graduates take the exam as soon after graduation as possible” (successful
graduate). “We need to encourage them to take the boards as soon after graduation as
possible. We know that the longer they wait, the more unsuccessful they are on the
exam” (administrator).
11. Explore the availability of NCLEX-RN review courses on computer. “We
should see if there are review classes on computer. We need to know what is available
to our graduates” (faculty member).
12. Utilize more student presentations and study groups in lecture. “Do more
student presentations in lecture” (successful graduate).
13. Survey the students as to how many have home computers. “We should do
a survey of students to see how many have computers at home” (administrator). “There
are 30 new computers ordered for the learning center and those will allow students
better computer access” (faculty member).
14. Include mathematics questions on every test during the program. “Mathis
on NCLEX, so maybe they need math tests throughout the program” (advisory commit
tee member).
15. Provide access to practice questions for the CAT version of the NCLEX-
RN. “We need to provide graduates access to practice computer questions” (faculty
member). “Historically, unsuccessful students have returned to the learning center and
are allowed to use the computer review programs, videos, and course syllabi that are
available there” (faculty member). “We could develop a ‘no credit’ class for those that
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have graduated to be able to come back to the learning center and practice with the tests
there” (administrator).
16. Explain the NCLEX-RN computer testing process to the students. "Maybe
you should explain how the test works to the students” (successful graduate).
17. Improve clinical judgment/critical thinking (patient situation videos for
class discussion). "Students need more critical thinking” (successful graduate). "Stu
dents should be taught to think on their feet and assimilate information quicker because
when they get to the computer the questions come quickly” (administrator). "Students
need to be able to make quick and accurate decisions to be successful on the exam”
(faculty member).
18. Work on delegation skills. "Since NCLEX has questions about delegation,
they need more information on it” (successful graduate).
19. Work on organizing a multipatient assignment. "The students need to be
able to manage a multipatient assignment to answer some NCLEX test questions” (ad
visory committee member).
20. Provide more information on prioritizing and time management. "There
were a lot of prioritizing questions on the test” (unsuccessful graduate).
21. Provide program test questions with one best answer, and review why an
swers on these tests are right and wrong. "Teachers should explain why the right an
swers on the test are right and why the wrong ones are wrong” (successful graduate).
22. The faculty must continue with their high expectations of students. “Faculty
are tough on the students but that has to be so that the students reach maximum potential
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in caring for patients and in passing the exam” (successful graduate). '‘One of our
terminal objectives is that our graduates be successful on the licensure exam, and we
need to look at how we can help them to do that” (administrator).
The unsuccessful graduates had the following responses to the questions regard
ing why they felt that they were not successful on the initial attempt at the examination
and what they would do different to prepare for the examination on the next attempt(s):
1. They did not prepare as they should for the first attempt. 'T did not take the
exam ‘seriously’ the first time” (unsuccessful graduate). “I needed to take the exam
more seriously and I should have worked harder during the entire nursing program”
(unsuccessful graduate).
2. They worked on a computer more, such as completed more practice tests on
computer. “I did a lot more on the computer after I failed the first time. That was better
than studying the books” (unsuccessful graduate).
3. They attempted to re-focus after the failure. “I tried to put the failure behind
me and not think about it so much” (unsuccessful graduate).
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CHAPTER 5
DISCUSSION
In this chapter the objective of the study and the research question of the study
are presented in the context of background information about the study area. A sum
mary of the study results is presented, followed by conclusions drawn from the results.
Implications of the study and recommendations for future research are discussed.
Study Objective, Research Question, and
Background Information
The objective of the study was to answer the following research question: How
can nursing school faculty prepare graduates for the computerized version of the li
censure examination (CAT version of the NCLEX-RN)?
The NCLEX-RN was developed by the NCSBN and the examination is de
signed to measure licensure candidates’ knowledge related to nursing. Over the years,
many changes have been made to the NCLEX-RN. It has progressed from a 2-day ex
amination divided into specialty sections (such as pediatric, medical-surgical, obstetric,
and psychiatric nursing) to a test with all specialties blended. The most recent change
was in April 1994, when the examination became computerized; it is now being given
via computer at various test sites. It lasts approximately 4 hours.
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Pass rates on the NCLEX-RN are very important to schools of nursing because
the measure of their success is their NLCEX-RN pass rate. Therefore, the number of
students that a program graduates is inconsequential in comparison to the NCLEX-RN
pass rate of the program. If students complete the program but do not pass the licensure
examination, they will not be allowed to practice as RNs. NCLEX-RN pass rates are
not only the best measure of success for schools of nursing; their ability to remain open
depends on those pass rates. The BRN accredits nursing programs. When BRN mem
bers come to the school for an accreditation visit, one of the criteria that is examined is
the program’s NCLEX-RN pass rate. If the pass rate is low compared to other programs
in the state, the program director and faculty of the program will have to explain why
and describe measures that will be taken to increase the pass rate. If the pass rate does
not improve, the Board will consider disciplinary action for the program. If the program
loses its accreditation or has it suspended, it must close its doors until the deficiencies
are addressed to the Board’s satisfaction.
The research population for the study consisted of students enrolled in commu
nity college ADN programs. The research sample included a community college ADN
program’s graduates, faculty members, administrators, and members of the advisory
committee.
Summary o f Study Results
The study included both quantitative and qualitative research. Data for the
quantitative part of the study were collected in the following manner. The files of all
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590 program graduates from May 1994 through May 2000 were collected. The list of
NCLEX-RN results for the program provided to the program director by the BRN was
used to separate the first-time failures (40) from the graduates who passed the examina
tion on the first attempt (550). The files of all 40 graduates who failed the examination
on the first attempt were used for the sample. The files of graduates who passed the ex
amination on the first attempt were selected for inclusion in the study by taking every
third file from the spring and fall semesters from May 1994 through May 2000 until 10
from each semester were selected (total 130). The following data were collected from
each file: gender, age, ethnicity, cumulative nursing course GPA, type of student, Eng
lish course taken, prerequisites taken prior to entering the program, and NCLEX-RN
results.
The following is a summary of the results of the study. The demographics of the
170 graduates in the sample resembled those of the students enrolled in the program in
the fall semester o f2001. The nursing graduates were mostly female, ages 20-35. The
majority of the graduates were Caucasian, followed by an almost equal mix of Asians
and Hispanics, followed by African Americans. Over 80% of the program graduates
were generic (nontransfer) students.
The graduates took at least 5 of the 10 prerequisite/corequisite courses before
entering the program. Most of the graduates took at least half of their prerequisites/co
requisites during the program, along with a full schedule of nursing courses. They took
at least two of the four required biology courses before entering the program. Since the
content of the nursing courses correlates closely with the biology courses, if a student
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has not had all of the biology courses prior to the nursing course, the student may be at a
disadvantage. The graduates were evenly divided as to which of the two English
courses they had taken. English I was taken by 37.6% of the graduates, English 105 by
36.5%, and 25.9% took English at another college. The majority of the graduates
(87.1%) had attended high school in the United States, 3.5% had attended a foreign high
school, and 1 graduate had attended high school both in a foreign country and in the
United States. Consequently, 87% had at least their high school education in English,
and almost half of the graduates (48.8%) had taken courses at a college and/or university
prior to the courses taken at the college where the nursing program was taught. The
percentage of the graduates having previous college degrees was 13.5%.
Multivariate analyses were performed to compare the following predictor vari
ables to the outcome variable of NCLEX-RN pass/fail: gender, age, ethnicity, student
type, English course taken, nursing course GPA, months elapsed from graduation to
taking the examination, where high school was attended, previous college courses or
degrees, number of prerequisite/corequisite courses taken prior to program entry, and
number of biology prerequisites taken prior to program entry.
The best predictor for NCLEX-RN success was cumulative nursing course GPA.
The graduates with the highest grades were more likely to pass the examination than
were those with lower grades. The mean nursing course GPA for those who passed the
examination was 2.74, and the comparable mean score for those who failed the exami
nation was 2.32. The relationship of GPA to NCLEX-RN results is documented in the
literature (Roncoli et al., 2000; Washington & Perkel, 2001). In the nursing program
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students must achieve at least a C grade in all nursing and biology courses to continue in
the program, whereas other departments require only a D grade. The overall college
GPA for students applying to the nursing program was 2.00. Since the cumulative nurs
ing course GPA for those who passed the examination was C+, the program must main
tain the expectation of a C grade or better in every nursing course. The faculty should
discuss the admission GPA of 2.00, as it is much lower than the 2.74 for graduates who
passed the examination. The ADN program faculty has discussed whether or not the 2.0
GPA admission requirement should be deleted, remain the same, or be increased. Other
departments of the college (such as journalism and fine arts) have no GPA admission
requirement. Since the mean GPA of those graduates who passed the exam was a 2.74
and that of those who failed was a 2.32, it would be most beneficial to the graduates if
the GPA was raised to a 2.4 for admission.
Ethnicity was highly significant to NCLEX-RN pass/fail. The relationship of
ethnicity to NCLEX-RN success was that both African American and Hispanic gradu
ates were more likely than Caucasians to fail the examination on the first attempt.
Asians did not have a statistically significant lower pass rate than the Caucasians. The
literature shows that minorities, especially African Americans, do not perform as well
on standardized tests as Caucasians (Bode & Gates, 2001; Roach, 2001; Roth, Bevier,
Bobko, Switzer, & Tyler, 2001). More data must be gathered as to why those two ethnic
groups have a higher failure rate than Caucasians. Variables such as socioeconomic
status, educational level of the parents, availability of computers at home, and availabil
ity of computers in the elementary and high schools that were attended should be
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considered. The nursing program should explore ways to significantly increase the pass
rate of African American and Hispanic graduates. Some suggestions would be struc
tured tutoring programs on a one-to-one basis or in a group, coordination of peer study
groups, and review courses for these students.
The statistics for relationship of student type (generic, LVN-to-RN, or transfer)
and NCLEX-RN pass/fail showed a trend of generic students having a higher pass rate
than the other two types. The work experience or previous educational background of
the LVN-to-RN students did not appear to increase their success on the examination.
The LVN-to-RN students entered the nursing program in the third semester and there
fore were not required to take the first-semester fundamentals of nursing nor the second-
semester medical-surgical nursing courses. The reason for that is that a graduate LVN is
equitable to an end-of-first-year RN student. The LVN students took a “bridge course”
before entering the RN program. The course reviewed basic nursing skills and nursing
care plans to prepare the LVN for entry into the RN program. A suggestion would be to
assign CD-ROM programs for these nursing students to review basic medical-surgical
nursing content.
The statistics for the relationship of which English course was taken (English I
or English 105) and NCLEX-RN pass/fail showed a trend of graduates who took Eng
lish 1 being more likely to pass the examination than those who took English 105. Ac
cording to Alfaro-LeFevre (1999), critical thinking is imperative for both nursing and
for passing the NCLEX-RN. Therefore, the fact that English I includes critical thinking
could explain why more of the students who took English 1 were more successful on the
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NCLEX-RN than were those who took English 105. The trend may be explained in that
those students with a higher GPA in the nursing courses had taken English 1 and those
with a lower GPA had taken English 105. As a consequence, the trend could be attrib
uted to the student’s GPA and not which English course was taken. The nursing faculty
should be involved in conducting research that would clarify the relationship between
the English course taken and NCLEX-RN pass/fail results. The faculty should also ex
plore the possibility of requiring English 1 as a prerequisite instead of English 105. The
critical thinking elements required in English I should benefit the graduates in their
nursing careers and increase their success on the licensure exam.
The relationship between time elapsed between graduation and taking the ex
amination was significant. Almost two thirds of the graduates took the examination
within 3 months following graduation. The longer the time span between graduation
and taking the examination, the higher the failure rate. Graduates must be encouraged
to take the NCLEX-RN as soon after graduation as possible in order to increase their
chance for success.
The following variables were not statistically significant to NCLEX-RN suc
cess: gender, age, attending a United States or foreign high school, previous college
courses or degrees, number of prerequisites or corequisites taken before entering the
program, and number of required biology courses taken prior to entering the program.
Nursing remains a predominantly female profession; however, male graduates are just
as successful on the NCLEX-RN as female graduates. A concern with the CAT version
of the exam is that older graduates may not have as much computer experience as
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younger graduates and thus be at a disadvantage on the exam; however, the statistics did
not show that to be true. Graduates who received elementary school and high school
education outside of the United States in a language other than English and in a different
educational system had the same success rate on the exam as those who were educated
in the United States in English. Although the number of prerequisite/co-requisite
courses (including the biology courses) taken during the program was not statistically
significant, historically program graduates have reported that they would have had less
stress and more understanding of nursing theory if they had completed all of these
courses prior to entering the nursing program.
Qualitative data were collected via focus groups and one-on-one interviews.
Four separate focus groups were conducted. Focus group one was composed of 31 pro
gram graduates who had passed the examination on the initial attempt and who volun
teered to participate in one of three focus group sessions. The graduates were eager to
participate in the study and offered excellent input regarding the preparation of gradu
ates for the CAT NCLEX-RN. Focus group two was composed of six program adminis
trators who volunteered to participate in a focus group. The group was very informed
about the mechanics of the computerized NCLEX-RN and offered some very important
observations. Focus group three was composed of four faculty members who volun
teered to participate in a focus group. The group was well informed about the mechan
ics of the CAT NCLEX-RN. They were eager to provide input to the researcher. Focus
group four was composed of five members of the advisory committee who volunteered
to participate in a focus group. An interesting observation was that the members of this
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focus group were not informed about the CAT version of the NCLEX-RN. They began
to ask the researcher about the examination, and the researcher gave a brief synopsis of
the computerized examination in order to refocus the group. Fourteen graduates who
did not pass the examination on the initial attempt participated in individual interviews.
Qualitative data were collected by note taking, the use of a tape recorder, and mailed
responses. All study participants gave consent to participate in the study and for a tape
recorder to be used during the focus groups.
The following were the themes resulting from the four focus groups and the
individual interviews. Overall, the study participants expressed that the program ade
quately prepared graduates for the NCLEX-RN. The program assists graduates in
preparing for the exam by the doing the following.
1. The program administers NLN exams during the program, especially the
comprehensive test in the fourth semester. Three of the NLN examinations have been
replaced by computerized examinations (mental health, pediatrics, and comprehensive).
The graduates who took the computerized tests during the program also expressed that
these tests were helpful in their preparation for the NCLEX-RN. Faculty should explore
the possibility of administering more commercially prepared or standardized tests via
computer during the nursing program.
2. The program times tests. Graduates reported that having the tests taken
during the nursing program timed at 1 minute per question helped them to “pace” them
selves on the NCLEX-RN. Although the NCLEX-RN is not a timed test, if a candidate
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takes the most number of questions possible (265) and takes the greatest amount of time
allowed (5 hours), that equals approximately 1 minute per question.
3. The program requires at least one computer-assisted program in each nurs
ing course. Both faculty and graduates stated that the more exposure a student had to
the computer, the more comfortable the student would be in taking the CAT version of
the NCLEX-RN. The computer-assisted programs currently required in the program
give the students exposure to and/or review of the mechanics of the computer and allow
practice with critical thinking skills under the pressure of a test.
4. The program uses textbooks with accompanying CD-ROM programs. The
CD-ROM programs that accompany textbooks allow students to practice on the com
puter and to practice critical thinking skills. Faculty should consider textbooks with ac
companying CD-ROM programs when evaluating new textbooks for the curriculum.
5. The program requires a computer class as a prerequisite. Both faculty and
graduates expressed that the program corequisite computer class was beneficial as it
helped the student to leam the basic information about a computer and increase the
comfort level on a computer. This class should be required before entry into the nursing
program.
6. The program promotes availability of computers to students in the college
library and in the school of nursing learning center. The availability of NCLEX-RN
review programs on computer in the school of nursing learning center was especially
helpful to the graduates. The program faculty and administration must encourage
graduates to utilize the available computer programs to review and prepare for the
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examination. These programs should be available to both current students and gradu
ates who are preparing for the licensure examination.
The following were suggestions for changes in/additions to the program that
would assist graduates to prepare for the NCLEX-RN.
1. The program should administer quiz questions that are similar to those on
the NCLEX-RN, such as questions with scenarios or patient situations, questions re
quiring priority setting, and questions having four answer choices that are all correct yet
one that is the best answer. Faculty should continue to revise the current test banks to
reflect the NCLEX-RN test questions. The questions should have all four correct an
swers, with one answer being the best answer. During quiz reviews, faculty should ex
plain why the correct answer is the best option out of all four choices so that the students
learn how to select the best answer from four correct choices. Test bank questions
should include questions about patient situations similar to the NCLEX-RN format.
2. The program faculty should suggest that the students take a computer class
as soon as possible, and before entering the program. It may be beneficial to require the
computer class prior to entry into the program.
3. The program should administering all or most tests via computer. Program
faculty should explore the feasibility of administering tests via computer. The remod
eled new learning center will have 30 new computers that could facilitate test adminis
tration via computer. Faculty could also explore creating three or four versions of each
test and allowing students to sign up for one of two or three appointment times to take
the test.
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4. The program should decreasing the amount of “straight lecture” and include
more discussion and case studies in lecture and campus lab time to facilitate critical
thinking. If the students were held accountable to prepare for lecture, there would be
more time for critical thinking and prioritizing exercises. Critical thinking and priori
tizing skills will help graduates in their nursing careers and on the licensure examina
tion.
5. The program should be offered requiring self-learning modules on the com
puter. There are many self-learning modules required throughout the program. If these
programs were placed on computer, the students would be allowed another opportunity
to work on a computer.
6. The program should offer the students online instructor office hours. The
students and instructors could conduct a dialogue via computer. This would offer the
students another opportunity to become familiar with the computer and would allow the
instructors to send out critical thinking questions to students and critique their responses
via computer.
7. The faculty should explain the CAT version of the NCLEX-RN to the stu
dents. During the leadership rotation, class time can be devoted to an explanation of
computerized testing, the CAT version of the NCLEX-RN, and study guidelines for the
examination.
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Limitations
The limitations of the study are as follows. The sample size was small in com
parison to the number of candidates who took the NCLEX-RN from May 1994 through
May 2000. The sample for the qualitative data was limited to those individuals who
volunteered to participate. Since only one ADN program was utilized for the study, the
results may not generalize to other ADN programs or to baccalaureate nursing pro
grams. More research is needed before the study results may be generalized to other
nursing programs.
Conclusions
Ethnicity. English course taken, and cumulative nursing course GPA were the
strongest variables that correlated to NCLEX-RN success. The data showed that Asians
and Caucasians had a higher pass rate than either African Americans or Hispanics. The
students who took English 1 for their English course had a higher pass rate than did
those who took English 105.
Although not statistically significant, the following trends were seen. Generic
nursing graduates were more likely to pass the examination than were the LVN-to-RN
graduates. The graduates who took the examination closest to their graduation date
were more likely to pass than those who waited longer following graduation.
No correlation was found between the following variables and NCLEX-RN pass
rate: gender, age, where high school was attended, previous college courses taken or
degrees received, number of prerequisites/corequisites taken before entering the pro-
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gram, or number of biology prerequisites taken before entering the program. Even
though these variables were thought to affect NCLEX-RN success, the results were not
statistically significant.
The results of the qualitative data were suggestions for changes in and additions
to the program that would help to prepare graduates for success on the CAT version of
the NCLEX-RN. If students are held accountable to prepare for lecture, there can be
time for discussion of patient situations and case studies. Utilizing lecture or campus
lab time for discussion would facilitate the use of critical thinking and priority setting
exercises and would therefore enhance those skills in the graduates and prepare them for
the test questions and their nursing careers. If more assignments and tests were given
via computer, the graduates would become familiar with the computer and their anxiety
would be decreased when taking the NCLEX-RN on computer.
Implications o f the Study
The national pass rate for ADN graduates on the NCLEX-RN in 2000 was
83.8% (NCSBN, 2002). Although the average pass rate from May 1994 through May
2000 for the ADN program utilized in this study was 93%, any improvement in that rate
will benefit the program. It has been well established that the NCLEX-RN pass rate of a
school of nursing is important to nursing school graduates, nursing school faculty, ac
crediting bodies for schools of nursing, and hospitals that hire new graduates. All of
those groups would benefit from any changes that would increase the NCLEX-RN pass
rate. Utilizing the information in this study to implement program changes may
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improve the pass rate and benefit the program. The study results could be utilized by
other nursing programs to make curriculum changes that could increase their NCLEX-
RN pass rates.
The following are topic areas that nursing faculty could explore:
1. Administration of weekly versus every-other-week quizzes/tests.
2. Inclusion of questions from previous courses on each test.
3. Inclusion of practice computerized NCLEX-RN questions followed by
discussion in the fourth semester leadership course.
4. Annual review of the content of the LVN program and the first year of the
RN program by the LVN and RN faculty to ensure equivalency in the content of both
programs and therefore improve the LVN-to-RN success in the RN program and on the
NCLEX-RN. The content of the LVN bridge course should be reviewed annually for
any necessary revisions to improve the success rate of LVN-to-RN students in the RN
program.
5. Timing of exams during the nursing program at 1 minute per question. Al
though the NCLEX-RN is not a timed exam, the candidate has a maximum of 5 hours
for the exam and can be given a maximum o f265 questions. If the candidate takes the
full amount of time (5 hours) and receives the maximum amount of questions (265) it
would equal to approximately 1 minute per question. Program graduates in focus group
one stated that the timing of their exams during the nursing program helped them to
pace themselves on the NCLEX-RN.
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Recommendations for Future Research
The following recommendations are made for future study:
1. A replication of this study using only generic students.
2. A replication of this study using only LVN-to-RN students.
3. A replication of this study using only baccalaureate students.
4. A replication of this study using only candidates who failed the examination
on the first attempt.
5. A replication of this study using a larger sample.
6. A replication of this study using a sample from more than one school of
nursing.
7. A qualitative study in which nursing graduates are interviewed immediately
before and immediately after taking the NCLEX-RN. Before the examination, they
could be asked how they prepared for the examination, and after the examination, they
could be asked what they felt was most helpful in preparing for the examination.
8. An experimental design in which an experimental group of nursing school
graduates is given a review course which would include (a) basic information about the
CAT version of the NCLEX-RN, (b) access to computerized practice NCLEX-RN ques
tions, and (c) discussion of the computer examination questions. A control group would
not be given the review course.
9. A descriptive study to investigate how many graduates with nursing course
GPA equal to or greater than 2.74 versus equal to or less than 2.32 (a) took all of the
prerequisite/corequisite courses prior to entering the nursing program, (b) took all of the
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biology courses prior to entering the nursing program, and/or (c) took English 1 versus
English 105.
10. A descriptive study to investigate how many graduates who passed the
NCLEX-RN on the first attempt continue their education and obtain a baccalaureate de
gree in nursing.
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REFERENCES
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REFERENCES
Alexander, J. E., & Brophy, G. H. (1997). A five-year study of graduates’ performance
on NCLEX-RN. Journal o f Nursing Education, 36, 443-445.
Alfaro-LeFevre, R. (1999). Critical thinking in nursing: A practical approach. Phila
delphia: Saunders.
Arathuzik, D., & Aber, C. (1998). Factors associated with National Council Licensure
Examination-Registered Nurse success. Journal o f Professional Nursing, 14, 119-
126.
Ashley, J., & O’Neil, J. (1991). The effectiveness of an intervention to promote suc
cessful performance on NCLEX-RN for baccalaureate students at risk for failure.
Journal o f Nursing Education, 30, 360-365.
Ashley, J., & O’Neil, J. (1994). Study groups: Are they effective in preparing students
for NCLEX-RN? Journal o f Nursing Education, 33, 357-364.
Baradell, J. G., Durham, C. F., Angel, B. F., Kaufman, J. S., & Lowdermilk. D. L.
(1990). A comprehensive approach to preparation for NCLEX-RN. Journal o f
Nursing Education, 29, 109-113.
Barkley, T. W., Rhodes, R. S., & Dufour, C. A. (1998). Predictors of success on the
NCLEX-RN among baccalaureate nursing students. Nursing and Health Care
Perspectives, 19, 132-137.
Beare, P. G. (1995). NCLEX-RN update: Helping your students prepare. Nurse Edu
cator, 20(3), 33-36.
Billings, D., Hodson-Carlton, K., Kirkpatrick, J., Aaltonen, P., Dillard, N., Richardson,
V., etal. (1996). Computerized NCLEX-RN preparation programs: A compara
tive review. Computers in Nursing, 14, 272-286.
Bode, S. K., & Gates, G. E. (2001). Correlate of success on the Registered Dietetic
Technician Credentialing Examination. Journal o f the American Dietetic Associa
tion, 101, 1473-1474.
98
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Breyer, F. J. (1984). The Comprehensive Nursing Achievement Test as a predictor of
performance on the NCLEX-RN. Nursing and Health Care, 5, 193-195.
Bridgeman, B., & Cline, F. (2000). Variations in mean response times for questions on
the Computer-Adaptive GRE General Test: Implications for fair assessment (GRE
Board Professional Report NO. 96-20P). Princeton, NJ: Educational Testing Serv
ice.
Briscoe, V. J., & Anema, M. G. (1999). The relationship of academic variables as pre
dictors of success on the National Council Licensure Examination for Registered
Nurses (NCLEX-RN) in a selected associate degree program. ABNF Journal,
10(4), 80-86.
Byrne, M. (2001). Data analysis strategies for qualitative research. AORN Journal, 74,
904-906.
Colombraro, G. C. (1989). NCLEX-RN preparation: Enabling candidates to pass.
Journal o f Continuing Education in Nursing, 20, 261-267.
Dell. M. S., & Valine, W. J. (1990). Explaining differences in NCLEX-RN scores with
certain cognitive and non-cognitive factors for new baccalaureate nurse graduates.
Journal o f Nursing Education, 29, 158-162.
DeSantis, L., & Ugarriza, D. N. (2000). The concept of theme as used in qualitative
nursing research. Western Journal o f Nursing Research, 22, 351-372.
Educational Testing Service. (1999). Frequently asked questions. Retrieved Octo
ber 3, 1999. from http://www.ets.org/cbt/faqed.html
Endres, D. (1997). A comparison of predictors of success on NCLEX-RN for African-
American, foreign-born, and White baccalaureate graduates. Journal o f Nursing
Education, 39, 365-371.
Feldt. R. C., & Donahue, J. M. (1989). Predicting nursing GPA and National Council
Licensure Examination for Registered Nurses (NCLEX-RN): A thorough analysis.
Psychological Report, 64, 415-421.
Felts, J. (1986). Performance predictors for nursing courses and NCLEX-RN. Journal
o f Nursing Education, 25, 372-376.
Forsythe, S. F. (1997). Identification ofpredictors for the NCLEX-RN and develop
ment ofan early assistance intervention fo r at-risk transfer students. Unpublished
doctoral dissertation, Nova Southeastern University, Fort Lauderdale, FL.
99
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Foti, I., & DeYoung, S. (1991). Predicting success on the National Council Licensure
Examination-Registered Nurse: Another piece of the puzzle. Journal o f Profes
sional Nursing, 7 , 99-104.
Fowles, E. R. (1992). Predictors of success on NCLEX-RN and within the nursing cur
riculum: Implications for early intervention. Journal o f Nursing Education, 31,
53-57.
Frierson, H. T., Malone, B., & Shelton, P. (1993). Enhancing NCLEX-RN perfor
mance: Assessing a three-pronged intervention approach. Journal o f Nursing Edu
cation, 32, 222-224.
Gallagher, A., Bennett, R. E., & Cahalan, C. (2000). Designing construct- irrelevant
variance in an open-ended computerized mathematics task (GRE Board Profes
sional Report No. 95-13P). Princeton, NJ: Educational Testing Service.
Gallagher, A., Bridgeman, B., & Cahalan, C. (2000). The effect o f computer-based
tests on racial/ethnic gender, and language groups (GRE Board Professional Re
port No. 96-21P). Princeton, NJ: Educational Testing Service.
Glick, O. J., McClelland, E., & Yang, J. (1986). NCLEX-RN: Predicting the perfor
mance of graduates of an integrated baccalaureate nursing program. Journal o f
Professional Nursing, 2, 98-103.
Hall, G. H. (1996). Critical thinking in nursing education. Unpublished doctoral dis
sertation, University of Minnesota, Minneapolis.
Horns, P. N., O’Sullivan, P., & Goodman, R. (1991). The use of progressive indicators
as predictors of NCLEX-RN success and performance of BSN graduates. Journal
o f Nursing Education, 30, 9-14.
Huepel, C. (1994). A model for intervention and predicting success on the National
Council Licensure Examination For Registered Nurses. Journal o f Professional
Nursing, 10, 56-60.
Jenks, J., Selekman, J., Bross, T., & Paquet, M. (1989). Success in NCLEX-RN:
Identifying predictors and optimal timing for intervention. Journal o f Nursing Ed
ucation, 28, 112-118.
Krupa, K. C., Quick, M. M., & Whitley, T. W. (1998). The effectiveness of nursing
grades in predicting performance on the NCLEX-RN. Journal o f Professional
Nursing, 4, 294-298.
100
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
LaPier, T. K., & Scherer, S. (2001). Evidence-based practice: When numbers are not
enough. Part II: Evaluating qualitative research studies. Cardiopulmonary Physi
cal Therapy Journal, 12(4), 126-129.
Lengacher, C. A., & Keller, R. (1990). Academic predictors of success on the NCLEX-
RN for associate degree nursing students. Journal o f Nursing Education, 29, 163-
169.
McClelland, E., Yang, J., & Glick, O. J. (1992). A statewide study of academic vari
ables affecting performance of baccalaureate nursing graduates on licensure exami
nation. Journal o f Professional Nursing, 8, 342-350.
Mills, A. C., Sampel, M. E., Pohlman, V. C., & Becker, A. M. (1992). The odds for
success on NCLEX-RN by nurse candidates from a four-year baccalaureate nursing
program. Journal o f Nursing Education, 31, 403-407.
National Council of State Boards of Nursing. (2002). National Council o f State Boards
o f Nursing home page. Retrieved January 26,2002, from http://www.ncsbn.org/
files/publications/positions/testing2.asp
Neuman, L. H. (1991). The relationship between admission/academic variables and
pass/fail performance on the National Council Licensure examination for Regis
tered Nurses (NCLEX-RN) in an LPN-RNprogram. Unpublished doctoral disserta
tion, University of Maryland, College Park.
Phillips, I. M. C. (1987). Test anxiety and the performance o f graduate nurses on the
National Council Licensure Examination for Registered Nurses. Unpublished
doctoral dissertation, Texas Southern University, Houston.
Powers, D. E., Burstein, J. C., Chodorow, M., Fowles, M. E., & Kukich, K. (2000).
Comparing the validity o f automated and human essay scoring (GRE Board Re
search Report No. 98-08aR). Princeton, NJ: Educational Testing Service.
Rami, J. S. (1992). Predicting nursing student’s success on NCLEX-RN. ABNF Jour
nal, 3(3), 67-71.
Riner, M. E., Mueller, C., Ihrke, B., Smolen, R. R., Wilson, M., Richardson. V., et al.
(1997). Computerized NCLEX-RN and NCLEX-RN preparation programs:
Comparative review. Computers in Nursing, 15, 255-267.
Roach, R. (2001). SAT minority achievement gap persists. Black Issues in Higher Ed
ucation, 18(16), 12-13.
101
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Roncoli, M., Lisanti, P., & Falcone, A. (2000). Characteristics of baccalaureate gradu
ates and NCLEX-RN performance. Journal o f the New York State Nurses Associa
tion, 31( I), 17-19.
Roth, P. L., Bevier, C. A., Bobko, P., Switzer, F. S., & Tyler, P. (2001). Ethnic group
differences in cognitive ability in employment and educational settings: A meta
analysis. Personnel Psychology, 54, 297-330.
Roye, T. V. (1997). Predictors o f performance on the National Council Licensure
Examination for Registered Nurses by associate degree graduates. Unpublished
doctoral dissertation, University of Flouston, Houston, TX.
Russell, M., & Haney, W. (1997). Testing writing on computers: An experiment
comparing student performance on tests conducted via computer and via paper-
and-pencil. Educational Policy Analysis Archives. Retrieved October 5,1999,
from http://olam.ed.asu.edu/epaayv5n3 .html
Ryan, P. K. (1997). The effect o f matricidation and intervention on three measures o f
success for three groups ofcommunity college nursing students. Unpublished
doctoral dissertation, United States International University, San Diego, C A.
Stevens, B. A. (1996). A study ofthe relationship between faculty qualifications and
program outcomes in schools ofnursing in West Virginia from 1985-1994. Unpub
lished doctoral dissertation. West Virginia University, Morgantown.
Stocking, M. L., Smith, R., & Swanson, L. (2000). An investigation o f approaches to
computerizing the GRE subject tests (GRE Professional Report NO. 93-08P).
Princeton, NJ: Educational Testing Service.
Stright, B. R. (1992). Predictors o f performance o f selected associate degree gradu
ates on the National Council Licensure Examination for Registered Nurses. Un
published doctoral dissertation, University of Pittsburgh, Pittsburgh, PA.
Vispoel, W. P. (1998). Psychometric characteristics of computer-adaptive and self-
adaptive vocabulary test: The role of answer feedback and test anxiety. Journal o f
Education Measurement, 33, 155-167.
Washington, L. J., & Perkel, L. (2001). NCLEX-RN strategies for success: A private
university's experience. ABNF Journal, 12(1), 12-16.
Waterhouse, J. K., Bucher, L., & Beeman, P. B. (1994). Predicting NCLEX-RN perfor
mance: Cross-validating an identified classification procedure. Journal o f Profes
sional Nursing, 10, 255-260.
102
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Woodham, R., & Taube, K. (1986). Relationship of nursing program predictors and
success on the NCLEX-RN examination for licensure in a selected associate degree
program. Journal o f Nursing Education, 25, 112-117.
Yang, J. C., Glick, O. J., & McClelland, E. (1987). Academic correlates of baccalaure
ate gradate performance on NCLEX-RN. Journal o f Professional Nursing, 3, 298-
306.
103
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
APPENDICES
104
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APPENDIX A
RESEARCH ON PREDICTORS FOR SUCCESS ON
THE CAT NCLEX-RN
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Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
RESEARCH ON PREDICTORS FOR SUCCESS ON THE
CAT NCLEX-RN
I Author(s)
| and Year Title Sample
Dependent
Variables
Independent
Variables Results
I Briscoe and Anemn
D (1999)
"Relationship o f Aca
demic Variables as
Predictors ol’Success
on the National Coun
cil Licensure Examina
tion for Registered
Nurses (NCLEX-RN)
in a Selected Associate
Degree Program”
38 associate degree
nursing graduates in
May 1997
NCLEX-RN pass/
fail
Age, gender, race, mar
ital status, per-adntis-
sion CiPA, grades in
clinical nursing
courses, grades on two
NLN tests
GPA and nursing course grades
did not significantly correlate
with NCLEX-RN success. NLN
scores, age, and race did corre
late with NCLEX-RN success.
| Roncoli, Lisanli,
fl and Falcone (2000)
Characteristics o f Bac
calaureate Graduates
and NCLEX-RN Per
formance
19 graduates who passed
NCLEX-RN and 19 who
failed
NCLEX-RN pass/
fail
Age, CiPA, course
grades, type o f nursing
program
No differences were found be
tween groups with relationship
to age or type o f program.
There was a significant differ
ence in the GPA and grades o f
the two groups: Those with A's
or B's were more likely to pass
than were those with C's.
(Prepared by Ronda M. Wood.)
o
O n
APPENDIX B
RESEARCH ON PREDICTORS FOR SUCCESS ON THE
PAPER-AND-PENCIL NCLEX-RN
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Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission.
RESEARCH ON PREDICTORS FOR SUCCESS ON THE
CAT NCLEX-RN
Aulhor(s)
and Year Title Sample
Dependent
Variables
Independent
Variables Results |
Briscoe and Ancmn
(1999)
"Relationship o f Aca
demic Variables as
Predictors o f Success
on the National Coun
cil Licensure Examina
tion for Registered
Nurses (NCLEX-RN)
in a Selected Associate
Degree Program”
38 associate degree
nursing graduates in
May 1997
NCLEX-RN pass/
fail
Age, gender, race, mar
ital status, per-admis-
sion GPA, grades in
clinical nursing
courses, grades on two
NLN tests
GPA and nursing course grades |
did not significantly correlate
with NCLEX-RN success. NLN
scores, age, and race did corre
late with NCLEX-RN success.
Roncoli, l.isunti,
H and Euleone (2000)
Characteristics of Bac
calaureate Graduates
and NCLEX-RN Per
formance
19 graduates who passed
NCLEX-RN and 19 who
failed
NCLEX-RN pass/
fail
Age, GPA, course
grades, type o f nursing
program
No differences were found be
tween groups with relationship
to age or type o f program.
There was a significant differ
ence in the GPA and grades o f
the two groups: Those with A's
or B's were more likely to pass
than were those with C's.
(Prepared by Ronda M. Wood.)
o
00
Author(s)
and Year Title Sample
Dependent
Variables
Independent
Variables Results |
Glick McClelland,
und Yang (1986)
"NCLEX-RN: Predict
ing the Performance o f
Graduates o f an Inte
grated Baccalaureate
Nursing Program”
51 graduates o f a bacca
laureate nursing pro
gram
NCLEX-RN pass/
fail
1 ligh school rank and
GPA, ACT scores,
grades from prerequi
site and nursing courses
Strongest predictors for success 1
in nursing courses were biology 1
GPA and prerequisite GPA. 1
Nursing course grades were sig
nificant in predicting success on
NCLEX-RN.
Wondhain and
T aubc(l986)
"Relationship of Nurs
ing Program Predictors
und Success on the
NCI,I:X>RN Examina
tion for Licensure in a
Selected Associate De
gree Program"
104 graduates of an as
sociate degree nursing
program between June
1981 und February 1982
NCLEX-RN pass/
Tail
Admission criteria
1 Yang, Glick, and
1 McClelland (1987)
"Academic Correlate
o f Baccalaureate Grad
uate Performance on
NCLEX-RN”
210 graduates o f a bac
calaureate nursing pro
gram who took the
NCLEX-RN in 1983,
1984,1985
NCLEX-RN
pass/fail
High school rank, ACT
scores, prerequisite
course grades, nursing
course grades
Nursing course grades were sig
nificant in predicting NCLEX-
RN pass/fail.
Krupa, Quick, and
Whitley (1988)
"Effectiveness of
Nursing Grades in Pre
dicting Pcrfonnance on
the NCLEX-RN”
384 baccalaureate nurs
ing program graduates
who took the NCLEX-
RN 1982-1985
NCLEX-RN pass/
fail
Nursing course grades GPAs for those who passed
NCLEX-RN were higher than
for those who failed. Theory
course grades substantially re
lated to pass/fail.
Feldl and Donahue
(1989)
. . .
"Predicting Nursing
GPA and National
Council Licensure Ex
amination for RNs
(NCLEX-RN): A
Thorough Analysis
155 students who com
pleted and 34 who failed
to complete a baccalau
reate nursing program
1984-1986.
NCLEX-RN pass/
fail
Nursing GPA, ACT
scores, prerequisite
course grades, high
school percentile
Best predictors for nursing GPA
were A C T composite score,
anatomy and chemistry grades.
Best predictor for NCLEX-RN
success were ACT composite
score, high school percentile,
nursing GPA, chemistry grade.
Author(s)
and Year Title Sample
Dependent
Variables
Independent
Variables Results
Jcnks, Selekman,
Bross, und Paquet
(1989)
"Success in NCLEX-
KN: Identifying Pre
dictors and Optimal
Timing for Interven
tion"
407 graduates o f an inte
grated , upper-division,
baccalaureate nursing
program 1984-1987
NCLI-X-RN pass/
fail
Previous university
GPA, credits earned
prior to matriculation
into nursing courses,
previous university sci
ence GPA, level of
previous university (2-
year or 4-year), grades
for the 6 clinical nurs
ing courses, age at
graduation, gender,
Mosby Assess lest
score
Nursing theory courses at the
junior ar.d senior years and the
Mosby Assess Test score strong
ly correlated with NCLLX-RN
performance. Students at risk
can be identified at the end o f
the junior year so that support
programs can be introduced.
.
Dell and Valine
(1990)
"Explaining Difler-
ences in NCLEX-RN
Scores With Cognitive
and Non-Cogniiive
Factors for New Bacca
laureate Nurse Gradu
ates”
78 senior generic nurs
ing students in three 4-
year nursing programs
NCLI-X-RN pass/
fail
Age, SAT scores, ACT
scores, collegiate GPA,
self-esteem tests
GPA, SAT/ACT scores, self
esteem and age accounted for
64% o f the variance o f the
NCLEX-RN scores; GPA alone
accounted for 58% o f the vari
ance, GPA was the best predic
tor o f success on the NCLEX-
RN.
1 Lengacherand
1 Keller (1990)
"Academic Predictors
o f Success on the
NCLI-X-RN for Asso
ciate Degree Nursing
Students”
146 associate degree
graduates admitted to a
specially designed asso
ciate degree nursing pro
gram
NCLI-X-RN pass/
fail
Admission variables
(entrance GPA, ACT
scores), age perception
o f role strain, achieve
ment in clinical and
nursing courses,
achievement on NLN
exams, exit GPA
Best predictor for performance
on NCLEX-RN were exit GAP
and ACT composite scores.
Best predictor for performance
o f nursing theory courses and
clinical courses were two theory
courses in second year of pro
gram, Best predictor o f NLN
exams were Basics Two exam
and Psychiatric Nursing exam.
Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission.
1 Author(s)
| and Year Title Sample
Dependent
Variables
Independent
Variables Results 1
1 Ashley and O ’Neil
D (1991)
"Effectiveness o f an
Intervention to Pro
mote Successful Per
formance on NC1.EX-
KN for Baccalaureate
Students at Risk for
Failure"
30 members o f a senior
class from a baccalaure
ate nursing program pre
paring to take licensure
exam in July 1989
NCLEX-RN pass/
fail
Nursing GPA, total
GAP, course grades for
specific nursing
courses, SAT scores,
Mosby Assess Test
scores
Overall, at-risk students
achieved 71% passing rate in the 1
examination, whereas 92% o f
the intervention group passed
the examination.
I Foti and DeYoung
| (1991)
"Predicting Success on
the National Council
Licensure Examina-
tion-Rcgistcrcd Nurse:
Another Piece o f the
Puzzle”
298 baccalaureate nurs
ing program students
1985-1988
NCLEX-RN pass/
fail
Overall GPA, GPA in
nursing, GPA in sci
ence, SA T scores, NLN
Comprehensive Bacca
laureate Achievement
l est scores, Mosby As
sess Test scores
Mosby Assesstest scores, overall
GPA, nursing GPA, NLN test
scores, and SA P verbal scores
were o f moderate predictive val- |
uc. Most useful combination in ■
predicting pass/fail on the exam
was Mosby Assess Test scores,
SAT verbal scores, and overall
GPA.
1 Horns, O ’Sullivan,
H and Goodman
H (1991)
“Use o f Progressive
Indicators as Predictors
o f NCLEX-RN Suc
cess and Performance
ofB SN Graduates”
408 baccalaureate nurs
ing students
NCLEX-RN pass/
fail
Preadmission variables
(gender, age, race, and
admission GPA),
grades for first two
clinical nursing
courses, grades for
mental health, adult
health and maternal
child nursing courses,
grades in two senior
clinical course, percen
tile rank on the NLN
comprehensive exam,
and graduate GPA
Preadmission GPA and race
were predictive variables for
NCLEX-RN success. Nursing
courses grades predicted
NCLEX-RN success.
Fowles (1992) "Predictors o f Success
on NCLEX-RN und
Within the Nursing
Curriculum: Implica
tion for Early Interven
tion”
192 graduates o f a bac
calaureate nursing pro
gram between 1985 and
1988
NCLEX-RN pass/
fail
ACT scores, lower di
vision GPA, anatomy
and physiology grades,
GPA at the end o f the
first year, GPA at end
o f second year, Mosby
Assess Test scores
GPA after the first quarter of
nursing courses. Mosby Assess
Test percentile, anatomy grade,
physiology grade, and ACT
scores were best predictors for
success on NCLEX-RN
Author(s)
and Year Title Sample
Dependent
Variables
Independent
Variables Results
McClelland, Yang,
and Click (1992)
■•Statewide Study o f
Academic Variables
Affecting Performance
o f Baccalaureate Nurs
ing Graduates on Li
censure Examination"
1,069 graduates o f Iowa
basic baccalaureate
nursing programs 1985-
1988
NCLEX-RN pass/
fail
High school GPA, ACT
scores, prerequisite
grades, nursing course
grades, Mosby Assess
Test scores
Prerequisite GAP was best pre
dictor o f success in nursing pro
gram, ACT scores were best pre
dictors on the Mosby Assess
Test, ACT composite score was
best predictor o f success on
Mosby Assess Test and
NCLEX-RN
Mills, Becker,
Sampel, and Pohl-
m an(l992)
"Success-Failure on
the National Council
Licensure Examination
for Registered Nurses
by Nurse Candidates
From an Accelerated
Baccalaureate nursing
Program"
328 first-time candidates
form 1982-1990
NCLEX-RN pass/
fail
Age, gender, education
in United States or out
side United States,
transfer GPA, each se
mester GPA for nursing
program
On the average, those who
passed were younger than those
who failed, GPAs were higher
for those who passed, more fe
males than males passed.
Mills, Sampel,
Pohlman, and
Becker (1992)
" The Odds lor Success
on NCLEX-RN by
Nurse Candidates from
Four-Year Baccalaure
ate Nursing Program”
534 first-time nurse can
didates between 1982
and 1990
35 graduates o f a newly
developed baccalaureate
nursing program
NCLEX-RN pass/
fail
NCLEX-RN pass/
fail
Age, sex, high school
GPA, nursing course
grades, ACT scores,
whether they trans
ferred from another
college
Prerequisite GPA, ACT
scores, NLN test scores
Successful candidates were gen
erally younger and had higher
high school GPA, ACT scores,
and nursing GPA than those
who failed.
Findings were inconclusive, hut
NLN scores were significant
predictors o f success on the ex
amination
Rami (1992) ••Predicting Nursing
Student's Success on
NCLI-X-RN”
Frierson, Malone,
and Shelton (1993)
"Enhancing NCLEX-
RN Performance: As
sessing a Three-
Pronged Intervention
Approach”
8 senior African Ameri
can baccalaureate nurs
ing students at a histori
cally Black university
NCLEX-RN pass/
fail
The students partici
pated in a special inter
vention program.
All 8 passed; the group pass rate
o f 100% was higher than the
pass rale o f 65% for spring se
mester graduates 1984-1987.
Author(s)
and Year Title Sample
Dependent
Variables
Independent
Variables Results
llucpel (1994) "A Model for Interven
tion and Predicting
Success on National
Council Licensure Ex
amination for Regis
tered Nurses”
152 basic students who
completed u baccalaure
ate nursing program be
tween 1985 and 1987
NCLEX-RN pass/
fail
Freshmen GPA, sopho
more GPA, junior
GPA, senior GPA, exit
GPA, grades for sci
ence courses and each
nursing course
Certain nursing courses and ju
nior year GPA were the most
strongly correlated variables
with NCLEX-RN success.
Waterhouse,
Bueher, and Bee-
nian(l994)
"Predicting NCLEX-
RN Performance;
Cross-Validating an
Identified Classifica
tion Procedure"
142 baccalaureate nurs
ing graduates between
1991 and 1992
NCLEX-RN pass/
fail
SAT scores, high
school percentile rank,
nursing course grades,
transfer from another
college or program,
took the ANR or not
The predictor equation from the
earlier study was validated.
Alexander and Bro-
p hy(1997)
"A Five-Year Study of
Graduates' Per
formance on NCLEX-
RN"
188 graduates from July-
1988 to February 1994
NCLEX-RN pass/
fail
Admission variables,
grades, NLN test scores
Strongest indicators for success
were SAT verbal scores, nursing
GPA, and NLN Comprehensive
Achievement l est scores.
l;ndres(1997) "Comparison o f Pre
dictors o f Success on
NCLEX-RN for
African-Americun,
Foreign-born, and
White Baccaluurcatc
Graduates"
50 African American, 50
forcign-bom, and 50
White baccalaureate
nursing graduates from
May 1987 to May 1992
NCLEX-RN pass/
fail
Nursing school admis
sion GPA, medical-sur
gical nursing GPA,
nursing cumulative
GPA, GPA at gradua
tion, percentile rank on
Mosby Assess Test, age
at time o f exam, num
ber o f semesters needed
to complete the pro
gram, prior LVN, num
ber o f D's and F'sin
nursing courses
There were no significant differ
ences in pass rates between the
African American, foreign-born,
While graduates, and prior
LVNs. students with D or F in a
nursing course and those who
failed Mosby Assess Test were
more likely to fail the exam.
GPAs for students who passed
were significantly higher. There
were no significant differences
in the ages o f those who passed
or failed the exam.
Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
Aulhor(s)
and Year Title Sample
Dependent
Variables
Independent
Variables Results 1
Arathuzik and Abcr
(1998)
•’Factors Associated
Willi National Council
Licensure Examina
tion-Registered Nurse
Success"
79 senior hucculaureate
nursing students
NCLI-X-RN pass/
fail
Demographic data,
nursing cumulative
GPA, English as pri
mary language, sense
o f competency, internal
blocks during program
(role strain, self-doubt,
ineffective use o f time,
poor study habits, low
motivation, emotions,
fatigue, self-induced
stress), external blocks
during program (fi
nances, family de
mands, family health
problems, lack o f sup
port, demands o f work,
living arrangements,
relationship strains)
Significant correlations were |
found between NCLI-X-RN sue-1
cess and nursing GPA, English
spoken at home, sense of com
petency, lack o f family responsi
bilities, and lack o f emotions
(anxiety, anger, guilt, and loneli
ness).
Barkley, Rhodes,
und D ufour(l998)
"Predictors o f Success
on the NCLI-X-RN
Among Baccalaureate
Nursing Students"
81 baccalaureate nursing
students (although no
dales arc given ns to
when the students com
pleted the program or
look the exam, no refer
ence is made to CAT
exam and literature re
view is all before the
CAT version)
NCLI-X-RN pass/
fail
Pediatric nursing
course grades and NLN
lest scores, adult nurs
ing course grades and
NLN test scores, psy
chiatric nursing course
grades and NLN test
scores, obstetrical nurs
ing course grades and
NLN test scores, and
nursing care o f the crit
ically ill course grades
Rank order o f correlations with
NCLEX-RN success: pediatric
nursing course grades, adult
NLN test scores, psychiatric
nursing course grades, psychiat
ric NLN test scores, obstetrical
NLN test scores, adult nursing
course grades, nursing care of
the critically ill nursing course
grads, pediatric NLN lest scores,
and obstetrical nursing course
grades.
(Prepared by Ronda M. Wood.)
APPENDIX C
PREPARATION FOR THE NCLEX-RN
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
PREPARATION FOR THE NCLEX-RN
Author(s)
and Year Title
NCLEX-RN
Version
Preparation
Method
Colombraro
(1989)
“NCLEX-RN
Preparation: En
abling Candidates to
Pass”
Paper-and-pencil Identification of learner
needs: 143 candidates were
interviewed as to whether or
not they felt they would pass
or fail the examination.
(Prepared by Ronda M. Wood.)
116
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
APPENDIX D
NCLEX-RN DISSERTATIONS
117
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Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
NCLEX-RN DISSERTATIONS
H Author(s)
| and Year Title Sample
Dependent
Variables
Independent
Variables Results I I
1 Phillips (1987) Test Anxiety and Per
formance o f Graduate
Nurses on the National
Council Licensure Ex
amination fo r Regis
tered Nurses
87 baccalaureate nursing
students in spring and
summer 1984
NC1.HX-RN pass/
fail
Marital status, test anxi
ety, minority status, in
come level o f parents,
number o f siblings at
tending college, number
o f children, number of
siblings, sibling rank,
means o f completing
high school, years in
college, age, sex, which
parents lived during
childhood, nice, educa
tional level o f parents,
parent participation in
community activities
High correlations were found |
between marital status and test
anxiety, and NCI.IiX-RN suc
cess.
Neuman (1991) Relationship Between
Admission/Academic
Achievement 1 'ariahles
and Pass*Fail Perfor
mance on the NCLEX-
RN in an I.PN-RN Pro
gram
332 graduates o f a com
munity college upward
mobility program front
1982-1990
NCIJ-X-RN pass /
fail
AC T Composite scores,
admission GPA, nursing
course grades, nonnurs
ing course grades, cu
mulative GPA, NI.N test
scores
The study findings support giv
ing I.VN's advanced standing in
RN programs, and additional
admission criteria may need to
be adopted for generic and LVN
students.
I Stright (1992) Predictors o f Perfor
mance o f Selected As
sociate degree Gradu
ates on the National
Council Licensure Ex
amination fo r Regis
tered Nurses
205 associate degree
nursing graduates
NCI.KX-RN pass/
fail
Age, high school rank,
score on entry math
tests, transfer status, en
rollment status, GPA at
end o f each semester,
anatomy and physiology
grades, NI.N Compre
hensive test scores
When taken together, none of
the variables appeared to distin
guish the pass group from the
fail group.
0 0
Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission.
Author(s)
and Year Title Sample
Dependent
Variables
Independent
Variables Results
Hall (1996) Critical Thinking in
Nursing Education
105 baccalaureate nurs
ing students
NCLEX-RN pass/
fail
Critical thinking ability,
age, gender, level o f
cognitive development,
socioeconomic status,
ACT score, college GI’A
As a groups, the students did not
possess adequate critical think
ing skills. Critical thinking and
financial status were significant
in predicting NCLEX-RN suc
cess.
Stevens (1996) Study o f the Relation
ship Between Faculty
Qualifications and
Program Attributes
and Student Outcomes
in Schools o f Nursing
in West Virginia From
1985 to 1994
All West Virginia pro
grams that graduated
students who were eligi
ble to take NCLEX-RN
between 1985 and 1994
NCL.EX-RN pass/
fail
Faculty attributes (de
grees held by faculty,
years o f teaching experi
ence, facully-studcnt
ratio, percent in full
time positions); program
attributes (NLN accredi
tation status, ratio o f
qualified applicants to
admission slots, number
o f graduates taking the
NCLEX-RN each year).
Faculty/student ration, percent
age o f faculty in full-time posi
tions, ratio o f qualified appli
cants to admission slots, and
years o f teaching experience of
the faculty had a relationship to
NCLEX-RN pass rale.
Forsythe (1997) Predictors o f Success
fo r the NCLEX-RN and
Development o f Early
Assistance intervention
fo r At-Risk Transfer
Students
All transfer students to a
university nursing pro
gram
NCLEX-RN pass/
fail
Four required science
courses transferred from
other universities
After intervention, there was a
significant increase in student
scores on the CAT NLN exami
nation.
Roye (1997) Predictors o f Perfor
mance on National
Council Licensure
Exam fo r Registered
Nurses by Associate
Degree Graduates
194 community college
nursing graduates who
completed the NCLEX-
RN in 1992,1993, and
1994
NCLEX-RN pass/
fail
Age, ACT scores, SAT
scores, and cognate
GPA
Students who passed the
NCLEX-RN were older than
those who failed. ACT scores,
SAT scores, and GPA were
higher for those who passed.
vo
Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
Author(s)
and Year Title Sample
Dependent
Variables
Independent
Variables Results
R yan(1997) Effect o f Matriculation
and Intervention on
Three Measures o f
Success fo r Three
Groups ofConununity
College Nursing Stu
dents
100 students who en
tered community college
nursing program be
tween fall 1987 and
spring 1992(52 required
to matriculate, 35 re
quired to matriculate for
English and math given
intervention program,
and 25 required to ma
triculate only)
NCI.EX-RN pass/
fail
GPA, Diagnostic Readi
ness Test scores
No significant difi'ercnces were
found between the groups.
(Prepared by Ronda M. Wood.)
to
o
APPENDIX E
PAPER-AND-PENCIL TESTING VERSUS CAT
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission.
PAPER-AND-PENCIL TESTING VERSUS CAT
Author(s)/Year Title Type of Test(s) Results
Russell and Haney (1997) “Testing Writing on Computers:
An Experiment Comparing Student
Performance on Test Conducted
via Computer and via Paper-and-
Pencil”
Middle school students’ perfor
mance on both multiple-choice
questions and written questions
administered via computer and
paper-and-pencil.
The multiple choice test results did not dif
fer significantly between the two modes of
administration. With the written test ques
tions, students who took the test via com
puter were more successful; they wrote
more than the others; students who were
accustomed to using a computer did better
than those who were not.
Vispoel(l998) “Psychometric Characteristics of
Computer-Adaptive and Self-
Adaptive Vocabulary Tests: The
Role of Answer Feedback and Test
Anxiety”
Computer-Adaptive-Testing
(CAT) versus Self-Adaptive-
Testing (SAT) vocabulary ex
ams.
The SAT version took longer. The CAT
was found to be more precise in predicting
ability.
Stocking, Smith, and
Swanson (2000)*
“An Investigation of Approaches
to Computerizing the GRE Subject
Tests”
Comparison of CAT and LOFT
GRE math and biology tests
Converting to computer testing seem viable.
H
Bridgentan and Cline
(2000)*
“Variations in Mean Response
Times for Questions on the
Computer-Adaptive GRE General
Test: Implications for Fair Assess
ment"
Explored whether questions
with a long response time ad
ministered via computer would
disadvantage test takers on the
CAT version of the GRE Gen
eral Test
There was no evidence that students who
received question requiring long response
times were placed at a disadvantage.
Gallagher, Bridgeinan,
and Cahalan (2000)*
“Effect of Computer-Based Tests
on Racial/Ethnic, Gender, and Lan
guage Groups”
Analyzed data from several
testing programs to determine
whether the change from paper-
and-pencil to computer tests
influenced performance of dif
ferent groups.
African American and Hispanic examinees
appeared to benefit from the computer test.
African American and Hispanic females did
slightly better on the computer test. Chinese
and Korean groups appeared to be disadvan
taged by the computer tests.
Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
Author(s)/Year Title Type ofTest(s) Results
Powers, Burstein, Chodo-
row, Fowles, and Kukicli
(2000)*
C om paring the Validity of A M o-
m a te d a n d H um an E ssay Scoring
Studied the validity of hand-
scored versus computer-scored
writing exams.
The two rating methods yielded similar re
sults.
Gallagher, Bennett, and
Cahalan (2000)*
D etecting C onstruct-Irrelevant
Variance in an O pen-E nded, C om
p u terized M athem atics Task
Examined a paper-and-pencil
versus a computer-graded math
test.
A preference by the examinees was shown
for the paper-and-pencil test.
National Council of State
Boards of Nursing (July
1990-November 1992)
Field testing Performed field testing before
implementation of the CAT
version of the NCLEX-RN
Performance on the paper-and pencil ver
sion was equal to that on the CAT version of
the NCLEX-RN.
♦ETS
(Prepared by Ronda M. Wood.)
I s )
U )

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Asset Metadata

Creator Wood, Ronda Marguerite (author)

Core Title Increasing graduate success on the CAT version of the NCLEX -RN

School Rossier School of Education

Degree Doctor of Education

Degree Program Education

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag education, community college,health sciences, nursing,OAI-PMH Harvest

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Hagedorn, Linda Serra (committee chair), Hitchcock, Maurice (committee member), Picus, Lawrence O. (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c16-235642

Unique identifier UC11339139

Identifier 3073865.pdf (filename),usctheses-c16-235642 (legacy record id)

Legacy Identifier 3073865.pdf

Dmrecord 235642

Document Type Dissertation

Rights Wood, Ronda Marguerite

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA