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Success Can Happen Out of Low Scores! Addressing Nursing Shortage with SCHOOLS
ACT Prep: A Kellogg Logic Model Theory of Change Removing Systemic Barriers to ACT
18 Score Attainment for Community College Admitted Pre-Nursing Students

Valencia Belle

Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education

August 2023

© Copyright by Valencia Belle 2023
All Rights Reserved

The Committee for Valencia Belle certifies the approval of this Dissertation

Jennifer Phillips
Kathy Stowe
Courtney Malloy, Committee Chair

Rossier School of Education
University of Southern California
2023

iv
Abstract
Addressing American College Testing (ACT) 18 score attainment failure is important to
improving ADN program viability as well as community college admitted pre-nursing students’
(CCAPNS) personal and professional growth, self-efficacy, and employability. The purpose of
this dissertation was to evaluate the effectiveness of the Success Can Happen Out of Low Scores
(SCHOOLS) test preparation intensive programs in increasing attainment rates of scores of 18 or
higher on the ACT. Four evaluation questions examined participants’ perceptions of the
program’s usefulness and the extent to which it and its components impacted their knowledge
about preparation practices and test processes, influenced their test self-efficacy, and increased
their score to at least 18. Results revealed a 50% or higher increase in satisfaction rates, test self-
efficacy, attainment of a score of 18, and mock composite post-test scores. Two
recommendations emerged for program assessment, planning, implementation, and evaluation.
Although failure to earn an 18 score on the ACT has been identified as an admission criterion-
related barrier to ADN program success, a research gap exists regarding evidence-based
admission policies to reduce attrition. The aim of this dissertation was to address the research
gap with an implementation-ready promising practice.

v
Dedication
This dissertation is dedicated to Edith Louise Mitchell and Louise Agatha Van Putten, the
matriarchs of my family located in the state of Alabama and St. Eustatius, Dutch West Indies,
respectively. Neither woman lived to see the day I became Dr. Valencia Belle, although this
accomplishment is the fulfillment of their wildest dreams for me as my ancestors.
In December 2022, I was blessed to travel to Statia with my best friends, Lydia Barnes
and Sonobia Robinson, to sit at my Aunt Louise’s bedside, reminding her that I was fulfilling the
promise I had made to her as a young biomedical researcher while visiting in my 20s - to help
more girls become great women - in STEM! My Aunt Louise believed in the Girls’ Brigade and
had dedicated her life to ensuring equity for all in the Dutch West Indies, especially for girls:
equity in educational access, college and career readiness, financial independence, family
systems stability, and political activism. I showed her a picture of my cap and gown, smiling,
dressed in full USC Doctoral regalia. Having served as a teacher and godparent for over 200
children without having a single biological child of her own, Aunt Louise was affectionately
known throughout Statia, the Dutch West Indies, and the entire Caribbean as “Teacher Louise”
and “Goddy.” For a brief moment, Goddy looked up, cocked her head to the right, stared straight
into my eyes, and smiled. I knew then that I would never see her alive again. She died on May
20, 2023, 10 days after I walked across the stage and was hooded in Los Angeles, California, as
my family from across the world virtually viewed the commencement.
Goddy, we did it!
In May 2009, I buried Mama Edie, my beloved grandmother, Edith Loise Mitchell. A
nurse-pioneer who served as a member of the Cadet Nurse Corps commissioned by the U.S.
government to care for the Certified Original Tuskegee Airmen (COTA), one of the first Black
vi
airmen in the U.S. Armed Forces. After graduating first in her class, she willingly returned to
Mobile, Alabama, at the recommendation of then Tuskegee Institute’s Dean of Nursing, Dean
Lillian Harvey, to found the first school of nursing for African Americans in Mobile, Alabama:
the Carver State Technical College’s Licensed Practical Nursing Program, now affiliated with
Bishop State Community College. Sixty-nine classes of nurses were blessed to glean from her
passion and purpose: equity both within and without the healthcare system. The struggle to
become a higher degree-seeking nurse as a second career was a difficult one for me, one that my
Mama Edie willingly and painstakingly walked through each storm of nursing in front of me,
leading the way with experience and expertise. I owe all that I am as a nurse to her in every way.
She was there to pin me into the nursing profession in 2006 at Virginia Commonwealth
University’s nursing graduation ceremony. Three years later, when my grandmother became ill
after passing my doctoral comprehensive examinations, I took a leave of absence from my PhD
in Educational Psychology at the University of Maryland, College Park, to relocate home to care
for her, as she had cared for me from birth until age 5. At the end of her life, she made me
promise her that I would overcome any and all obstacles to becoming Dr. Belle, even if she
never lived to see that day.
Mama Edie, we overcame it!
I cannot express enough thanks to my immediate family that endured “all” that was the
arduous doctoral journey with me - My father, Donald Belle; my mother, Antoinette “Toni”
Belle, my Grand-Aunt, Dorothy Mitchell, my sister, Anitra Belle-Henderson and her husband
Demetrius, my nieces, Kierstyn Johnson, Raven Henderson, and Rian Henderson. Thank you to
all my cousins—Faith, Hope, Charity, Joy, Natalie, Carol, and Dawn—as well as their
immediate husbands, children, and family members. To Uncle Bubba, Nannie Carolyn, and
vii
Nannie Wanda, thank you for your encouragement and support as we grieved the loss of Uncle
Fleet, Rev. Dr. Fleet L. Belle, and Nannie Doris, Doris Bell, during my time as a doctoral student
at USC.
Twenty-one COVID-related deaths of friends and family later, after being wheelchair
bound for 1 and a half years after breaking both ankles, surviving two hospitalizations for
pneumonia and an emergent cardiac surgery secondary to a pulmonary embolism from serving as
a health educator and healthcare provider on the frontline fighting the pandemic, I graduated. I
stand as a living testament to the will to “Fight On”, and I vow to encourage as many future
Trojans as possible to do the same! I’ve also learned so many valuable lessons regarding
resilience in the face of adversity from Marvin Jones. Thank you for your unwavering love,
support, and commitment to see this process through to the end. Thank you to my “dissertation
sisters”- Dr. Trevare Sherman, Dr. Kim Morton, Dr. Heather Triana, and Dr. Tina-Marie Terrasi
- Dr. Martin Payne, and the “family” that is Cohort 17! To my SCHOOLS family – the Dovis,
the McAlpines, Jessica, Amari, Naomi, Kim, Brittany, Monique, Mrs. Ruth, Todd, Cassaundra,
Brenton, and Cameron – thank you for all that you do for children and SCHOOLS!
Dr. Vareva Harris, my “dissertation midwife”, thank you for birthing the finished product
with your expert evaluative critiques that helped to strengthen my resolve to become the best
scholar-practitioner that I could be! To my editors -Sara Kathleen Henry, Silvia Pettway, and
Guadeloupe Montano- your editorial assistance was invaluable!
In the things of God, only absolute certainty will do. I am certain that God gave me the
topic of this dissertation and completed the work through me. It is now my responsibility to live
my life fulfilling the call of Christ toward equity—in social services, healthcare, and education—
viii
helping as many girls as possible who look like me worldwide fulfill their dreams to do more
than I could ever do!
As Mama Edie would say, “To ALL there IS.” and to ALL that can FOREVER be…

ix
Acknowledgments
I wish to sincerely acknowledge my committee for its guidance and expertise in crafting
the research design and educational policy initiative. Dr. Courtney Malloy, my Chair, was
critical in formulating the design of the survey, which added so much value to the responses
gathered from CCAPNS using a mixed-methods approach. To Dr. Kathy Stowe and Dr. Jennifer
Phillips, my sincerest thanks to you both for your encouragement throughout the process. You
both helped a very shy academic researcher find her voice, and then gave her the courage to
address educational inequity from a policy standpoint, a feat I would have never attempted prior
to your challenging me to do so. Dr. Malloy gave me the courage to let the data tell the story of
nursing shortage from the personal perceptions of the CCAPNS I am honored to serve through
test preparation! Dr. Stowe’s words to “tell us what will happen. … Will patients die?” during
my defense if my problem of practice was not addressed resonated with me for weeks afterward.
Dr. Phillips made me come to terms with the implications of not addressing the policy aspects of
my problem of practice for the greater good. Although I initially did not want to see more
capable nurses lose access to the pursuit of higher degrees in the nursing profession from the lack
of an ACT 18 score to advance to nursing school upper division (NSUD), I soon realized the
potential magnitude of this implementation-ready program in occasioning higher rates of ACT
18 score attainment for CCAPNS and increased rated of NSUD admission for community
college ADN programs if the evaluation results supported systemic adoption. I have been blessed
to systematically implement SCHOOLS in two community colleges since the inception of this
dissertation’s research and have helped more than 30 new nurses enter the profession. For this, I
am forever grateful to have lessened nursing shortage, even if only for a few.

x
Attending USC allowed me to become a servant-leader for the online USC community of
Trojans, allowing me to interact with my committee members in several leadership capacities.
Thus, I can truly say that Dr. Malloy, Dr. Stowe, and Dr. Phillips embody the mission and vision
of the Rossier School of Education in word and in deed. USC gave me the opportunity to meet
Dr. Douglas Lynch and Professor Mark DeGennaro, participate in the USC EdVentures Cohort
IV Ed-Tech Accelerator, pitch at the 2022 ASU+GSV Symposium, and return as an ASU+GSV
G Cup Elite Finalist Ed-Tech company in 2023, noted as one of the top 200 Ed-Tech companies
globally. I was even allowed to present my findings at Rossier’s inaugural Research for Impact
Symposium, an innovative educational equity initiative of Rossier’s Dean Pedro Noguera. I am
forever indebted to USC for these opportunities to expand my test-prep company into a goal-
based learning workforce development solution.

Fight On!
xi
Table of Contents
Abstract .......................................................................................................................................... iv
Dedication ........................................................................................................................................v
Acknowledgments.......................................................................................................................... ix
List of Tables ............................................................................................................................... xiii
List of Figures ................................................................................................................................xv
List of Abbreviations ................................................................................................................... xvi
Chapter One: Introduction to the Study ...........................................................................................1
Background and Context......................................................................................................3
Overview of SCHOOLS ......................................................................................................4
Purpose of the Evaluation ....................................................................................................6
Significance of the Evaluation .............................................................................................7
Evaluation Approach ...........................................................................................................9
Definition of Terms............................................................................................................15
Organization of the Dissertation ........................................................................................17
Chapter Two: Literature Review ...................................................................................................19
Overview of the ACT.........................................................................................................19
Overview of Nursing Shortage ..........................................................................................28
Summary ............................................................................................................................39
Chapter Three: Methodology .........................................................................................................41
Evaluation Questions .........................................................................................................41
Overview of the Design .....................................................................................................41
Data Collection Procedures................................................................................................49
Validity and Reliability ......................................................................................................50
Ethics..................................................................................................................................50
xii
Chapter Four: Results ....................................................................................................................52
Participants .........................................................................................................................53
Demographics ....................................................................................................................54
Research Question 1: CCAPNS’ Knowledge About ACT Preparation Practices and
Test Processes ....................................................................................................................58
Research Question 2: CCAPNS’ Self-Efficacy .................................................................64
Research Question 3: Overall Program Perceptions of Usefulness of Program
Components and CCAPNS’ Satisfaction with the SCHOOLS ACT Preparation
Program ..............................................................................................................................65
Research Question 4: ACT 18 Score Attainment Rate Effectiveness ...............................73
Summary ............................................................................................................................78
Chapter Five: Impact and Recommendations ................................................................................79
Discussion of Findings .......................................................................................................79
Recommendations ..............................................................................................................81
Delimitations and Limitations............................................................................................86
Recommendations for Future Research .............................................................................87
Conclusion .........................................................................................................................89
References ......................................................................................................................................91

xiii
List of Tables
Table 1: Modalities for SCHOOLS 6
Table 2: Rates of Nursing Shortage 8
Table 3: SCHOOLS Logic Model 12
Table 4: ACT by Subject Area (Total Number of Questions) 20
Table 5: State of Alabama ACT Score Passing Percentages 20
Table 6: ACT 18 Attainment by Subject Area (Correct Questions Needed/Total Number of
Questions) 21
Table 7: Black–White Test Score Gap Statistics from 2021 National ACT Test Result
Percentages 23
Table 8: U.S. ACT Prep Companies Rates 24
Table 9: ACT Prep Companies’ Service Modalities, Score Increases, and Guarantees 26
Table 10: Alabama State Department of Education College and Career Readiness High
School Graduation Requirements 27
Table 11: 2021 U.S. Registered Nurse Population 31
Table 12: Levels of Nursing Practice with Years of Nursing Training and Degree Obtained 32
Table 13: Nursing Hourly and Yearly Salaries by Designation 34
Table 14: Net Benefit Comparisons 36
Table 15: Data Sources 42
Table 16: 2021 Elm Community College Demographics 45
Table 17: ACT Preparation Program Intensive Participation 53
Table 18 Gender 54
Table 19: Race/Ethnicity 55
Table 20: Gender of Participants from Archival Program Records Review Data 56
Table 21: Race/Ethnicity of Participants from Archival Program Records Review Data 57
Table 22: Archival Data Program Records Review Participant Responses to Last Grade in
Math and Science 58
xiv
Table 23: Percentages of Responses to Questions Regarding ACT Registration 60
Table 24: Percentages of Responses to Questions Regarding ACT Subject Area Questions 61
Table 25: Percentages of Responses to Questions Regarding ACT Test Scoring 62
Table 26: Percentages of Responses to Questions Regarding ACT Self-Efficacy Scoring 65
Table 27: Survey Respondents’ Ratings of SCHOOLS Program Components 67
Table 28: Survey Responses to NSUD Application 75
Table 29: Survey Responses to NSUD Admission 76
Table 30: Survey Responses to ACT 18 Score Attainment 77

xv
List of Figures
Figure 1: Supply and Demand Projections 29
Figure 2: The Obsidian Principle 37
Figure 3: ACT Mock Composite Score Pre-Intensive and Post-Intensive 74

xvi
List of Abbreviations
ACT American College Testing
ADN Associate Degree in Nursing
BIPOC Black and Indigenous People of Color
BSN Bachelor of Science in Nursing
CCAPNS Community College Admitted Pre-Nursing Student
CNA Certified Nursing Assistant
FGCS First-Generation College Student
LPN Licensed Practical Nurse
NCLEX-RN National Council Licensure Examination for Registered Nurses
NSUD Nursing School Upper Division
RN Registered Nurse
SCHOOLS Success Can Happen Out of Low Scores
1

Chapter One: Introduction to the Study
The world is currently in a serious nursing shortage, with a global need of nine million
nurses by 2030 for all countries (World Health Organization, 2020). A nursing shortage,
characterized by a discrepancy between the supply and demand for registered nurses, typifies a
condition in which the demand for employment of nurses exceeds the available supply of nurses
willing to be employed at a given salary (Grumback et al., 2001; Workman, 2021). Globally,
nationally, and at the state level, the nursing shortage negatively affects healthcare delivery and
positive patient outcomes (Buchanan, 2008; Zarea & Negarandeh, 2009). As nurses serve as the
largest group of direct and indirect healthcare providers for various healthcare settings in most
industrial countries, nursing shortage increases patient harm and suffering, diminishes patient
care, increases hospital malpractice expense, and escalates medication error-related deaths (Fry
& Dacey, 2007; Zarea & Negarandeh, 2009).
The nursing shortage could decrease by increasing registered nurse (RN) licensure rates
through community college associate degree of nursing (ADN) matriculation. However, this path
is challenging. Many community college admitted pre-nursing students (CCAPNS) face access,
advisement, and assistance barriers limiting nursing program completion, especially students
who are first-generation college students (FGCS), Black, Indigenous, and people of color
(BIPOC) students, LatinX students, and students from rural communities with limited internet
access (Banks et al., 2018; Bennett et al., 2021; Card & Rothstein, 2007; Evans, 2015; Levitt,
2017; Nguyen et al., 2015; Stage et al., 2013).
In the United States, the nursing shortage further complicates by a shortage of nurses of
color, men in nursing, and minority and male faculty nurse educators to meet the growing
demands of the U.S. minority population. While 40% of the 2021 U.S. population identified as
2

people of color (Frey, 2021), only 19.4% of the 2020 U.S. RN workforce were from minority
backgrounds (Smiley et al., 2020). Regarding gender, men represented 9.4% of the 2020 U.S.
RN population and only 7.4% of the 2021 U.S. full-time nursing school faculty (HRSA, 2010;
Smiley et al., 2020). With the minority population becoming the U.S. majority by 2045,
providing high-quality care will require RNs to demonstrate culturally competent care, with
sensitivity and understanding across a variety of healthcare settings and cultures, to confront
racial and ethnic disparities in healthcare that lead to unequal treatment producing adverse
patient outcomes in minority communities (Egede, 2006; U.S. Department of Health and Human
Services Office of Minority Health, 2000; Smiley et al., 2020; Stith et al., 2002).
In Alabama, the ADN program is offered at many of the 24 community college nursing
programs (NursingLicensure.org, 2021). While admission requirements vary, one specific
requirement remains constant: an American College Testing (ACT) score of 18 or higher.
Although this score is not a requirement for high school graduation or nursing licensure at any
level in Alabama (ABN, 2021a), failure to earn that score poses a barrier to nursing school upper
division (NSUD) advancement, increasing nursing shortage.
Nursing literature lists ACT composites and subscores among the gold standards for
admissions indicators with predictive validity of successful performance on the National Council
Licensure Examination for Registered Nurses, or the NCLEX-RN exam, despite national efforts
to abate the use of standardized testing as admission criteria due to issues of fairness and bias
(Aldag & Rose, 1983; Gilmore & Lyons, 2012; Grossbach & Kuncel, 2011; Higgins, 2005;
Phelps, 2003; Urdan & Paris, 1994). Several authors have found that overall success in nursing
programs, with subsequent success on the NCLEX-RN, was predicted by pre-admission ACT
subscores in math and science (Crow et al., 2004; Gallagher et al., 2001; Roncoli et al., 2000).
3

Drawing on the predictive validity of the exam as an indicator of nursing school success, many
U.S. nursing programs require a score of 18 for admission to NSUD despite potential
socioeconomic, environmental, and community issues with the test’s use at the state and national
level, such as Alabama’s high school graduate ACT pass rate (among the lowest in the United
States) or the U.S. Black–White ACT test score gap stemming from decades of systemic racial
segregation nationally (“Black Students’ Scores,” 2021; World Population Review, 2022).
Facing pressures to increase new enrollment, expedite workforce entry, and maintain new
graduate NCLEX-RN licensure exam first attempt pass rates at levels at 80% or higher, several
U.S. nursing schools initiated requirements for an ACT score of 18 without careful consideration
of the impending issues with and implications of the requirement’s enforcement (Adamson &
Young, 2012; Giddens, 2009; Jeffreys, 2012; Murray et al., 2008).
This dissertation aimed to evaluate a program in one Alabama community college
designed to provide test preparation support for CCAPNS. The dissertation examined Success
Can Happen Out of Low Scores (SCHOOLS) to learn more about its effectiveness in CCAPNS
attaining an ACT score of 18. The dissertation’s evaluation also addressed participants’ self-
efficacy, program satisfaction, and perceptions of the program’s usefulness.
Background and Context
Since its inception in the 1950s, the development of the ADN program has significantly
impacted the U.S. RN population (Mahaffey, 2002; Post University, 2021). Although almost half
of U.S. RNs with a bachelor’s degree in nursing (BSN) began their nursing education in a 2-year
ADN program, failure to reach a score of 18 on the ACT prohibits NSUD advancement across
the United States generally and in Alabama, specifically (Nursing Explorer, 2022; Nursing
Schools Almanac, 2022). Moreover, this failure inhibits progression for students seeking a
4

quicker, flexible alternative to entering the nursing profession (Nursing Explorer, 2022; Nursing
Schools Almanac, 2022).
Access, advisement, and assistance to gain high-quality, cost-effective test preparation
could strengthen the college- and career-readiness from K–12 to the workforce for all students.
In addition, BIPOC, LatinX, and FGCS face environmental and community factors that may
inhibit economic advancement secondary to low ACT score attainment. Environmental and
community factors, such as systemic racial segregation, Black–White standardized test score
gap, and unmet financial needs, are perceived to prevent earning a score of 18, prohibit
advancement to NSUD, and halt the acquisition of RN licensure (Card & Rothstein, 2007;
Evans, 2015; Yosso, 2005).
One promising approach to increasing success rates on the ACT and NSUD advancement
is standardized test preparation embedded in pre-nursing school course selection for community
college systems. The SCHOOLS ACT test preparation program is available to students through
select community colleges or by self-pay onsite or online. To increase the rates of CCAPNS
earning a score of at least 18 on the ACT, SCHOOLS offers two modalities of test preparation: a
2-week and a 5-week iteration at Elm Community College (a pseudonym). This dissertation
consisted of a formative evaluation of SCHOOLS to better understand how Elm Community
College implements the program and offer recommendations for improvement.
Overview of SCHOOLS
The program focus of this dissertation was SCHOOLS at Elm Community College.
SCHOOLS aimed to provide high-quality, cost-effective, standardized ACT preparation to
CCAPNS (SCHOOLS, 2021). SCHOOLS has offered standardized test preparation to 2000
students annually since 2009. The goals of SCHOOLS were to increase ACT 18 score attainment
5

rates and CCAPNS’ agency, or decision-making power, to forecast their next steps toward RN
licensure.
Like many community colleges, Elm Community College struggled to provide test
preparation services over multiple campuses covering large geographical distances where
internet access and transportation were issues. Finances also played a role in registration for test
preparation and the actual ACT exam. Like many community colleges, Elm Community College
sought ways to offer test preparation services that required little or no community college staff or
administrative support after registration. Elm Community College sought to contract with a test
preparation program that produced high ACT 18 score attainment levels to help increase NSUD
admission rates for CCAPNS. A special focus for test preparation at Elm Community College
was CCAPNS seeking RN licensure to service urban and rural medical centers. To mitigate these
concerns, Elm Community College began to offer SCHOOLS ACT test preparation embedded in
their pre-nursing school course selection after a strategy meeting with the Coordinator of
Workforce Solutions, the Division of Workforce Development, the Dean of Instruction, and the
Interim Dean of Health Sciences.
Table 1 details key activities for each of the two modalities of ACT preparation delivered
to CCAPNS at Elm Community College by SCHOOLS, online only and onsite, for $155 and
$250, respectively. The full ACT preparation intensive offered online and onsite courses
covering 1,250 review questions and met five times for 4-hour live instructional sessions over 5
weeks. The refresher preparation intensive offered online-only courses, covered 625 review
questions, and met eight times for 1-hour live instructional sessions over 2 weeks. The full and
refresher modalities included 8 hours of homework provided online and 24/7 access to the
SCHOOLS learning management system.
6

Table 1
Modalities for SCHOOLS
Inputs Full ACT prep intensive Refresher ACT prep intensive
Cost $250 $155
Cost offerings Online and onsite Online only
Class times Once weekly
Saturdays (10a–2p) and
Sundays (4p–8p)
Daily
Monday–Thursday (10a–11a)
Instructional sessions Five (4-hour) sessions 8 (1-hour) sessions
Duration 5 weeks 2 weeks
Homework 8 hours (online) 8 hours (online)
LMS access 24 hours
7 days/week
Online
24 hours
7 days/week
Online

Note. Adapted from Modalities for SCHOOLS Programs Standardized Test Prep Intensives by
SCHOOLS Programs, 2022. (https://www.schoolsprograms.org). Copyright 2023 by SCHOOLS.

Purpose of the Evaluation
The purpose of this dissertation was to evaluate SCHOOLS at Elm Community College.
Specifically, this dissertation examined the program’s effectiveness in increasing CCAPNS’
ACT 18 score attainment rates. This dissertation also addressed participants’ self-efficacy,
program satisfaction, and perceptions of usefulness. The dissertation’s evaluation addressed the
following questions:
1. To what extent are CCAPNS knowledgeable about the ACT preparation practices and
test processes?
2. To what extent does the ACT preparation program influence the test self-efficacy of
CCAPNS?
7

3. What are the perceptions of CCAPNS regarding the usefulness of the ACT
preparation program and its components?
4. To what extent is SCHOOLS effective in increasing CCAPNS’ ACT 18 score
attainment rates?
The current dissertation used a mixed-methods survey and archival records data for
analysis. The mixed-methods survey analyzed the responses of recent program completers during
6 months from November 2022 to April 2023. Archival records data taken from program
completers over a 4-year, 7-month period from January 2018 to October 2022 were also
analyzed. Program records data and survey analysis assessed CCAPNS’ self-efficacy, program
satisfaction, and perceptions of usefulness for SCHOOLS.
Significance of the Evaluation
Despite the prominence of ADN programs across the United States and in Alabama,
imminent health care and nursing shortages throughout the nation reflect a need to increase the
enrollment of ADN nursing school graduates to reduce staffing shortages (Registered
Nursing.org, 2022). Table 2 presents global, national, and Alabama nursing shortage rates. The
World Health Organization (WHO) noted a shortage of 9 million nurses globally by 2030 for all
countries (World Health Organization, 2020). The U.S. nursing shortage, cyclically presenting
since the 1900s, has reached critical levels since the dawn of the coronavirus pandemic, with
175,900 RN openings yearly through 2029, a trend expected to continue from 2030 and beyond
(Elgie, 200; Mehdaova, 2017). In 2021, Alabama employed 79,771 registered nurses for a 2020
state population of 5,100,000, or 15.6 working registered nurses available per 1,000 residents
(ABN, 2021b; PopulationU.com, 2021). Consequently, the state declared a state of disaster
related to the nursing shortage and COVID, allowing licensed nurses to enter the Alabama nurse
8

workforce for 30 days without an Alabama license, with many other states either waiving
licensure requirements or expediting temporary licensure (National Council of State Boards of
Nursing [NCSBN], 2021).

Table 2
Rates of Nursing Shortage
Location Statistic
Globally 9 million RNs by 2030
United States 175,900 RN openings yearly through 2029
Alabama 15.6 working RNs available/1,000 residents
(2021)

Note. From Strategies to overcome the nursing shortage by E. A. Mehdaova, 2017, Walden
University. State response to COVID-19 (APRNs) by National Council of State Boards of
Nursing, 2021. https://www.ncsbn.org/public-files/APRNState_COVID-19_Response.pdf),
Alabama population by PopulationU.com,2021. (https://www.populationu.com/us/alabama-
population), and Nursing and midwifery by WHO, 2020. (https://www.who.int/news-room/fact-
sheets/detail/nursing-and-midwifery)

9

When levels of nursing shortage increase, especially in public health crises like the
COVID-19 pandemic, more patients to care for are assigned to existing workforce nurses. For
every extra patient per nurse, Aiken et al. (2002) found a 7% increase in the odds of patient
failure to rescue and the likelihood of dying within 30 days. In the U.S. in 2021, there were 80
million cases and over 870,000 deaths due to COVID-19, which impacted nursing outcomes,
with 76% of nurses reporting, on average, a three-fold increase in nurse-patient ratios, or the
number of nurses who care for an assigned number of patients (Centers for Disease Control,
2021; ICN, 2021). Nurse exhaustion, burnout, and stress, coupled with increased nurse-patient
ratios, are dangerous to nurses and harmful to patients, associated with turnover, poor patient
outcomes, medication errors, and significant financial impacts on hospital systems (Bae et al.,
2010; Hall et al., 2016; Hirose et al., 2018; ICN, 2018).
The dissertation’s evaluation of SCHOOLS holds significance in nursing education at the
community college level. This evaluation could offer an implementation-ready best practice for
adoption for community colleges that do not routinely incorporate ACT preparation courses in
their CCAPNS pre-nursing plan of study covered by financial aid (ACCS, 2021). Without
measures to assess course quality and financial assistance to obtain high-quality, cost-effective
test preparation, many CCAPNS may be left without access, assistance, or advisement, limiting
their score attainment and nursing licensure capabilities. Moreover, more evidence-based
programs are needed to address the nursing shortage. As ACT is a barrier to advancement,
SCHOOLS and its evaluation could be of benefit.
Evaluation Approach
A program theory approach guided this dissertation’s evaluation. The Kellogg logic
model used a transdisciplinary and results-oriented management research lens and assessed
10

SCHOOLS (Donaldson, 2007; Scriven, 2003; Wholey, 2003; W. K. Kellogg Foundation, 2004).
Donaldson (2007) operationalized program theory-driven evaluation science as “the systemic use
of substantive knowledge about the phenomena under investigation and scientific methods to
improve, to produce knowledge and feedback about, and to determine the merit, worth and
significance of evaluands such as social, educational, health, community, and organizational
programs” (Donaldson, 2007, p. 9). Coryn et al. (2011), in their literature review of 45 cases of
theory-driven evaluations published over 20 years, stated that the typical application of program
theory-driven evaluation includes a theory-driven, yet empirically based, evaluation utilizing five
core principles: “theory formulation,” “theory-guided question formulation and prioritization,”
“theory-guided planning, design, and execution,” “theory-guided construct measurement,” and
“identification of breakdowns and side effects, determining program effectiveness or efficacy,
and causal explanation” (Coryn et al., 2011, pp. 212–215).
This dissertation’s evaluation employed both a transdisciplinary view of evaluation and
results-oriented evaluation management. Scriven (2003) stated that the transdisciplinary view of
evaluation encompasses an enlightened view and use of the triangular role of program theories,
including the program theory presumed, the actual program logic, and the idyllic program theory.
Wholey (2003) stated that utilizing logic models guides results-oriented management by
incorporating program theory. This evaluation approach is appropriate for the study because it
helped frame the theory of SCHOOLS to focus on evaluating the critical outputs and outcomes.
Table 3 details the dissertation’s logic model for the program. As seen in Table 3,
SCHOOLS had several inputs from the Elm Community College’s Workforce Development
Office and its program. Elm Community College’s Workforce Development Office was
responsible for the following inputs: CCAPNS recruitment, registration, and ACT preparation
11

intensive course payment, CCAPNS registration for testing, stakeholder partnership development
with nursing workforce hiring agencies, and CCAPNS access to Wi-Fi, enabling the use of
Google Classroom, Google Meets, and interaction with SCHOOLS. The inputs that SCHOOLS
was responsible for included all teaching and training materials needed to conduct ACT
preparation, including instructors, instructional resources, online registration assistance, social
media presence building, and dissemination of data management.

Table 3
SCHOOLS Logic Model
Resources Activities Outputs Short- and long-term
Outcomes
Impact
To accomplish our set of
activities, we will need
the following
To address the
problem or asset,
we will accomplish
the following
activities
We expect that once
accomplished, these
activities will
produce the
following evidence
or service delivery.
We expect that if
accomplished, these
activities will lead to the
following changes in 1–3,
then 4–6 years.
We expect that if
accomplished,
these activities
will lead to the
following
changes in 7–
10 years.
Workforce development
Registration workforce
development ACT prep
course with payment
Site pre-nursing residual
ACT testing (national
residual ACT testing site
certification)
Site NSUD registration
policies and procedures
CCAPNS participant
recruitment
SCHOOLS ACT Prep
Funding (workforce
development funds or
self-funded with student
funds)
Site stakeholder
partnerships developed
Deliver 5-week full
(onsite/online)
SCHOOLS ACT prep
tutoring program,
onsite/online
program
5-week full
Deliver 20 hours of
onsite/online
instruction
5 sessions/4 hours
each
Saturdays 10 am–2
pm CST
Sundays 4 pm–8 pm
CST

Deliver 2-week
refresher (online
only) SCHOOLS
Number of students in
5-week Full
Program
(onsite/online)

Number of students in
2-week refresher
program (online
only)

CCAPNS placement
workforce
development full or
refresher ACT prep
course
Self-selection
Payment
$289 5-Week Full
$189 2-week
refresher
Short-term outcome: 2
months

SCHOOLS ACT prep
program dissemination
2 rotations
5-week full program
4 rotations
2-week refresher program

CCAPNS participant
satisfaction rates
50% or higher express
participant satisfaction

CCAPNS self-efficacy rates
50% or higher express
increase in self- efficacy

25% increase in
the rate of
NSUD
Advancement
for CCAPNS in
7–10 years
12

Resources Activities Outputs Short- and long-term
Outcomes
Impact
Communication with key
stakeholders (internal
and external)
CCAPNS access
Wi-Fi
Google Classroom
Google Meets

SCHOOLS programs
ACT prep
ACT prep program
management
Instructional resources
(ACT manuals, LMS,
curriculum, Remind
app)
Program staff and tutors
onsite and online
Tutors for ACT prep and
ACT remediation
ACT fee registration and
assistance vouchers
(High school free fee
waiver voucher
retrieval method)
Social media presence
built (internally and
externally)
Dissemination of data
management
ACT prep tutoring
program
Online program
2-week refresher
Deliver 8 hours of
online instruction
8 sessions/1 hour
each
Monday–Thursday
10 am–11 am
CST
2-week rotation

Provide online ACT
registration
assistance
National ACT
registration only,
not residual ACT
site-based testing

Pre-mock ACT tests

Post-mock ACT tests

Onboarding
completion with 3
SCHOOLS forms
completion

CCAPNS attendance
rates
QR code scans for
attendance
Google Classroom
logins

CCAPNS ACT
content completion
rates
(ACT English,
Math, Reading,
Science)
QR code scans for
attendance
Google Classroom
logins
Google Meets
attendance
Homework
documents
completed
(scanned or
uploaded into
Google
Classroom)

CCAPNS participant
satisfaction rates

SCHOOLS ACT prep
program completers post-
mock score increase
50% of a higher rate of
post-test score increase
over baseline pre-test
scores when assignments
are completed
beginning-to-end and
within-subject
assessments

CCAPNS ACT 18
attainment rate goal met
50% or higher rate of ACT
18 score attainment for
program completers

Long-term outcome: 25% or
higher decrease in
CCAPNS student attrition
rates due to ACT 18 score
attainment failure
13

Resources Activities Outputs Short- and long-term
Outcomes
Impact
SCHOOLS
student/parent
contract
SCHOOLS and
JEMS evaluation
form
SCHOOLS
demographic form

Remind app
registration

Google Classroom
onboarding
ACT prep classroom
ACT manuals
download
ACT additional
Materials
Download QR codes
for digital sign-in
scan sheets
CCAPNS participant
self-efficacy rates
14
15

Program activities, key outputs, and short-term outcomes were as follows. The program
activities included delivery of SCHOOLS as one of two modalities: a 5-week (onsite or online)
session or a 2-week (online only) session. Delivery of the intensives included online ACT
national test registration assistance, Google Classroom learning management system onboarding
(preparation classroom, manuals, and additional material downloads), completion of the three
SCHOOLS forms, Remind app, and QR code registration for constant contact and attendance
taking through digital scanning, and administration of pre-mock and post-mock ACTs. Key
outputs from program activities were the number of CCAPNS participants in either modality by
self-placement and payment; attendance rates measured by QR code scans and Google
Classroom logins; ACT content completion rates for each of the four subject areas (English,
Math, Reading, and Science) from QR code scans; Google Classroom logins; Google Meets
attendance; completed homework submissions; and participant self-efficacy and satisfaction
rates. The short-term outcomes immediately after completion of the anticipated 6 months of
program dissemination, including six 5-week cycles and twelve 2-week cycles of ACT
preparation, included knowledge increased by 50%, self-efficacy increased by 50%, participant
satisfaction with and usefulness of SCHOOLS increased by 50%, and ACT 18 score attainment
increased by 50%.
Definition of Terms
Lunenburg and Irby (2008) stated that clarification of key terms is paramount to the
study, as they are referenced and used throughout the dissertation. The following terms
operationalize for this dissertation:
American College Testing (ACT): a standardized test developed by ACT, Inc., measuring
English, Math, Reading, Science, and Writing for college admissions (ACT, 2016). This
16

dissertation used only the ACT composite score, which averages scores in each area (ACT,
2021).
ACT 18 Score: Often required for advancement in nursing programs, earning a score of
18 on the ACT requires acquiring the following scores in each section of the ACT (English [41–
43 correct questions of 75 questions total], Math [23–25 correct questions of 60 questions total],
Reading [21–22 correct questions of 40 questions total], Science [16 correct questions of 40
questions total) or an average composite score of 18 from the English, Math, Reading, and
Science subscores of the ACT (ACT, 2021).
Associate degree in nursing (ADN): An ADN is an expedited path to facilitate RN
licensure, where students obtain an RN license and an associate degree in arts and sciences with
2 to 3 years of study, which is the minimum educational requirement for RN status in Alabama
(NursingLicensure.org, 2021).
Community college admitted pre-nursing student: A community college admitted pre-
nursing student is a community college student admitted as a pre-nursing student seeking ACT
18 score attainment to apply, be accepted, and advance to NSUD (ACCS, 2021).
Licensed practical nurse (LPN): An LPN is a graduate of an accredited school of nursing
who has become licensed to provide basic nursing care under the supervision of an RN or a
physician (Dictionary, 2022).
National Council Licensure Examination for Registered Nurses Exam (NCLEX-RN): the
licensure examination developed by the NCSBN that member board jurisdictions use to assist in
making licensure decisions. The licensing authorities regulate entry into nursing practice in each
NCSBN member board jurisdiction (state, commonwealth, and territorial boards of nursing).
Each jurisdiction requires candidates for licensure to meet set requirements, including passing an
17

examination that measures the competencies needed to perform safely and effectively as a newly
licensed entry-level RN to ensure public protection (NCSBN, 2016).
Nursing school upper division (NSUD): The NSUD is the portion of the nursing school
directly following the completion of pre-nursing core courses immediately preceding hospital
clinical care preceptorship, which requires the attainment of a score of 18 on the ACT for
advancement at many of the 24 community colleges in Alabama (Wallace State Community
College, 2021).
Registered nurse (RN): An RN is a nurse who has graduated from a nursing program and
met the requirements outlined by a country, state, province, or similar government-authorized
licensing body to obtain a nursing license. Legislation determines an RN’s scope of practice,
which a professional body or council regulates (Registered Nurse, 2022).
Success Can Happen Out of Low Scores (SCHOOLS): a program that provides high-
quality, cost-effective, standardized ACT test preparation (SCHOOLS, 2021).
Self-efficacy: agency as the expression of exerted control over essential life elements and
motivation to enact changes from feedback received through reciprocal interactions (Bandura,
1997).
Organization of the Dissertation
This dissertation contains five chapters. Chapter One includes the introduction to the
dissertation, including the purpose statement and the dissertation’s problem of practice, the
context and background of the dissertation, an overview of SCHOOLS and its two program
modalities, the purpose of the evaluation, the importance of the evaluation, the evaluation
approach, the logic model developed, and a definition of terms. Chapter Two contains an in-
depth literature review, including an overview of factors affecting ACT 18 score attainment, an
18

overview of the nursing shortage, an overview of diversity, equity, and inclusion issues for
nursing shortage, an overview of the pathways to nursing licensure, and an overview of self-
efficacy and other psychological factors, followed by a summary. Chapter Three includes a
description of the methodology used in the dissertation, which includes the four evaluation
questions, an overview of the research design, the research setting description, a statement of the
researcher’s positionality, a description of the two data sources – an anonymous survey and
archival program records from 2018–2022, participants, instrumentation, data collection
procedures, program documents, reliability and validity measures, and ethical considerations.
Chapter Four presents the dissertation’s findings, including descriptive statistics, with analyses
of the logic model’s effectiveness, the archival records data review, and the anonymous mixed-
methods survey for answering the four research questions. Chapter Five summarizes the entire
dissertation, including an overview of the problem, purpose statement and research questions,
methodology review, study findings, delimitations, limitations, future research
recommendations, and concluding remarks.

19

Chapter Two: Literature Review
ACT 18 score attainment failure for CCAPNS inhibits NSUD advancement, prohibits RN
licensure, decreases rates of diversity, equity, and inclusion in the nursing workforce, and
increases rates of nursing shortage. The focus of the problem of practice for this dissertation
deals with nursing education and its essential role in reducing rates of nursing shortage. Nursing
education is essential to increasing ACT 18 score attainment rates, thus promoting advancement
to NSUD. This dissertation examined several topics to understand the relationship between ACT
18 score attainment failure and the nursing shortage. These topics include the ACT; ACT 18
score attainment; factors affecting score attainment; nursing shortage; diversity, equity, and
inclusion issues for nursing shortage; the pathways to nursing licensure; and self-efficacy and
other psychological factors.
Overview of the ACT
The ACT is a standardized test that measures English, Math, Reading, Science, and
Writing for college admissions (ACT, 2016). The exam has four composite score sections, each
with its separate subscore and a total number of questions. The composite score derives from an
average of the English, Math, Reading, and Science subscores, which may range from 1 to 36.
The Writing subscore, which may range in scores from 1 to 12, is not included in the composite
score. The highest score possible to achieve on the ACT is a 36.
Table 4 lists the number of questions for each composite score section (ACT, 2021).
There are 75 questions for English and 60 for Math. The Reading and Science sections consist of
40 questions each.

20

Table 4
ACT by Subject Area (Total Number of Questions)
Subject area Total number of questions
English 75
Math 60
Reading 40
Science 40

Note. Adapted from ACT history by ACT, 2021. (https://www.act.org/content/act/en/products-
and-services/the-act.html)

In 2019/2020, 1.67 million students took the ACT in the U.S. The average composite
score was 20.6, with 36 being the highest. Table 5 presents results from Alabama (World
Population Review, 2022). The average composite score for Alabama was 18.8. Fifty-one
percent of Alabama students passed English, 35% passed Math, and 23% passed Reading. Only
24% passed overall (World Population Review, 2022).

Table 5
State of Alabama ACT Score Passing Percentages
Subject area Percentage
English 51%
Math 35%
Reading 23%
Overall 24%

Note. Adapted from 2021 State of Alabama ACT Score Passing Percentages, by World
Population Review (https://worldpopulationreview.com/state-rankings/average-act-score-by-
state). Copyright 2021 by- World Population Review.

21

Overview of ACT 18 Score Attainment
Table 6 presents the minimum number of correct answers from the total questions
required in each section to earn a composite score of 18 (ACT, 2021). The English section
consists of 75 questions, and earning a score of 18 requires 41–43 correct questions. For Math,
there are 60 questions, of which 23–25 must be answered correctly to reach a score of 18. Of the
40 questions in the Reading section, 21–22 must be answered correctly. Finally, 16 out of 40
questions must be answered correctly for Science.

Table 6
ACT 18 Attainment by Subject Area (Correct Questions Needed/Total Number of Questions)
Subject area Correct questions needed Total number of questions
English 41–43 75
Math 23–25 60
Reading 21–22 40
Science 16 40

Note. Adapted from ACT history by ACT, 2021. (https://www.act.org/content/act/en/products-
and-services/the-act.html)

22

Individuals may score more correct questions in the four ACT composite score
subsections than the minimum number required. Scoring higher in each subsection may increase
individual subscores. Thus, ACT 18 score attainment also operationalizes as an average
composite score of 18 from the ACT English, Math, Reading, and Science subscores.
Overview of Factors that Affect ACT 18 Score Attainment
Four factors have been found to affect ACT 18 score attainment: environmental and
community factors, ACT preparation cost factors, ACT preparation service modality, score
increase and guarantee factors, and college and career readiness factors. Implications of the
socio-historic, socio-environmental, and socioeconomic effects of the four factors affect
CCAPNS’ ability to advance their nursing licensure trajectory from CNA to BSN, impacting
their wage-earning potential gained from higher nursing degree advancement. A detailed
discussion of each factor follows.
Environmental and Community Factors
Environmental and community factors are perceived to influence ACT 18 score
attainment rates, prohibit CCAPNS advancement to NSUD, and halt the acquisition of RN
licensure (Card & Rothstein, 2007; Evans, 2015; Yosso, 2005). A literature review revealed
several U.S. environmental and community factors annually affecting the college and career
readiness of students aged 18 and under. These factors included systemic racial segregation,
Black–White standardized ACT test score gap, and unmet financial needs (Card & Rothstein,
2007; Evans, 2015).
Table 7 addresses the Black–White standardized ACT test score gap in the U.S. (“Black
Students’ Scores,” 2021). A 2021 comparison of Black and White test takers nationwide rated
test takers ready for college-level courses by ACT subject area. In English, 67% of Whites and
23

28% of Blacks were rated ready for college-level courses. In Math, 44% of Whites and 10% of
Blacks were rated as such. In Reading, 53% of Whites and 18% of Blacks were rated ready. In
Science, 44% of Whites and 11% of Blacks were rated ready for college-level courses. Whites
were considered five times as likely as Blacks to be prepared for college-level courses (“Black
Students’ Scores,” 2021).

Table 7
Black–White Test Score Gap Statistics from 2021 National ACT Test Result Percentages
Race Black White
English 28% 67%
Math 10% 44%
Reading 18% 53%
Science 11% 44%

Note. Adapted from “2021 Black White Test Score Gap Statistics – National ACT Test Result
Percentages” by The Journal of Blacks in Higher Education, 2021.
(https://www.jbhe.com/2021/10/black-students-scores-on-the-act-test-continue-to-fall-and-the-
racial-gap-widens/). Copyright 2021 by The Journal of Blacks in Higher Education.

24

ACT Preparation Cost Factors
Table 8 compares the ACT preparation costs for the three leading U.S. preparation
companies. Preparation courses are often costly and self-funded, yet necessary to earn a score of
18 or higher. These costs are usually not covered by U.S. need-based federal financial aid.
National U.S. vendor fee-for-service costs can sometimes price test preparation at levels that are
financially out of reach for CCAPNS. CCAPNS who choose to enroll in SCHOOLS have ACT
preparation course costs covered by their U.S. need-based federal financial aid, as both the
refresher and full intensive courses list as courses embedded in the community college course
catalog for selection through the Division of Workforce Development (SCHOOLS, 2021).

Table 8
U.S. ACT Prep Companies Rates
Company Cost Preparation course service
modality
Prep Scholars $995 Virtual
Kaplan $749 Virtual, 6 months self-paced
$549 Virtual tutor
$199 Self-paced
Princeton Review $2,199 Virtual, 1 year self-paced
Virtual/in-person tutor
$175/hour 6 months
Virtual/in-person tutor
$368/hour Virtual/in-person tutor

Note. Adapted from ACT prep courses by Kaplan, 2022 (www.kaptest.com/act/act-courses).
Copyright 2022 by Kaplan. Adapted from Test prep ACT by Prep Scholar Pricing, 2022.
(www.prepscholar.com/act/s/pricing). Copyright 2022 by Prep Scholar. Adapted from Princeton
Review ACT Prep by Princeton Review (www.princetonreview.com/college/act-test-
prep?ceid=newhp-nav-1). Copyright 2023 by Princeton Review.
25

ACT Preparation Service Modality, Score Increase, and Guarantee Factors
Table 9 compares preparation service modalities, score increases, and score increase
guarantees for the three leading U.S. ACT prep companies. Factors such as the course’s
modality, the score increase guarantee or stated measure to repeat the course in the event of score
attainment failure, and the ACT preparation instructional competence affect ACT 18 score
attainment. These preparation courses are often only offered online, which may present access
issues for individuals with limited internet access. Score increase guarantees for the cost of
services purchased are nonexistent or minimally given by U.S. national vendors. As there is no
national standardization for the test preparation industry, instructors who teach many of the
courses may have yet to achieve ACT certified educator status or be nationally certified by ACT.
Those who enroll in SCHOOLS have ACT preparation courses disseminated onsite and online.
At SCHOOLS, the preparation refresher and full intensives are priced at $155 and $250,
respectively, ensuring that retaking the course is financially feasible (SCHOOLS, 2021).
For most U.S. vendors, online modalities require internet broadband coverage. Onsite
modalities require multiple weekly visits for 3 to 6 months to 1 year with minimal or no score
increase guarantee. For most onsite U.S. vendors, onsite modalities require travel of 30 or more
miles to predetermined high-traffic locations in major metropolitan cities for three weekly in-
person visits for 3 to 6 months to 1 year with minimal or no score guarantee. Individuals who
take these courses may need more finances, internet, or transportation assistance to take
advantage of these services.

26

Table 9
ACT Prep Companies’ Service Modalities, Score Increases, and Guarantees
Company Service modality Score increase Guarantee
Prep Scholars Online +4 points Yes
Kaplan Online +1-2 points None/minimal
Princeton Review Online
On-site
6 months–1 year
+1-2 points None/minimal

Note. Adapted from ACT prep courses by Kaplan, 2022 (www.kaptest.com/act/act-courses).
Copyright 2022 by Kaplan. Adapted from Test prep ACT by Prep Scholar Pricing, 2022.
(www.prepscholar.com/act/s/pricing). Copyright 2022 by Prep Scholar. Adapted from Princeton
Review ACT Prep by Princeton Review (www.princetonreview.com/college/act-test-
prep?ceid=newhp-nav-1). Copyright 2023 by Princeton Review.

College and Career Readiness Factors
Table 10 lists the 10 Alabama State Department of Education’s College and Career
Readiness High School Graduation Requirement Benchmarks. In November 2022, the Alabama
State Superintendent of Education enacted a plan beginning with the 2028 high school
graduating class that all students must have one college and career readiness benchmark to
graduate from an Alabama high school (Powell Crain, 2022). Three of the 10 benchmarks
directly correlate to ACT test score results. With Alabama ranking as the sixth poorest state,
increasing post-secondary educational attainment opportunities is paramount as both a moral and
economic imperative (Alabama Possible, 2021).

27

Table 10
Alabama State Department of Education College and Career Readiness High School Graduation
Requirements
Alabama State Department of Education high school graduation benchmarks (2027–2028)
A benchmark score in any subject area of the ACT college entrance exam
A three or higher on an advanced placement exam
A four or higher on an international baccalaureate exam
A college credit while still in high school
A silver or gold on the ACT WorkKeys Exam
An in-school youth apprenticeship program
A career technical industry credential listed on the Alabama Committee on Credentialing and
Career Pathways compendium of valuable credentials
A military acceptance before graduation
A career and technical education completer status
Any other college and readiness indicator approved by the State Board of Education

Note. Adapted from “Alabama adds new high school graduation requirements for Class of 2028”
by T. Powell Crain, 2022. November 10. Advance Local.
(https://www.al.com/educationlab/2022/11/alabama-adds-new-high-school-graduation-
requirement-for-class-of-2028.html). Copyright 2023 by Advance Local Media LLC

While the ACT measures school accountability and college and career readiness, students
who attain low scores often experience a gatekeeping effect, limiting their economic
advancement. In 2021/2022, the graduation rate for Alabama was 96%. However, the college
and career readiness percentage was 76%. Governor Kay Ivey issued a success plan to create
500,000 new credentialed, highly skilled workers by 2025 to meet the state’s economic industry
labor demands (The Office of Governor Kay Ivey, 2022). In addition, Governor Ivey issued four
education-focused executive orders in 2022 to address the state’s numeracy and literacy to
“increase Alabama’s national ranking in our students’ reading and math performance.”
28

prioritizing the creation of new “first class pre-k classrooms” in counties where 20% or more of
the population falls below the federal poverty guidelines (The Office of Governor Kay Ivey,
2022).
Overview of Nursing Shortage
Figure 1 depicts factors that contribute to the nursing shortage, including supply and
demand, aging of the workforce, vacancy rates, recruitment and retention, work environment
factors, staffing levels, turnover, workload, autonomy, managerial relations, compensation,
international recruitment, demographic factors, and nursing education (Workman, 2021).
Limited staffing and depleted resources strain nurses and healthcare systems, increasing the
severity and frequency of occupational injury and human capital depletion (Covell & Sidani,
2013; Halbesleben, 2010). Subsequently, as members of the nursing workforce many times
dually serve as nursing faculty, nursing shortage in the nursing profession stems from the lack of
nurse educators, the high rate of turnover, and the inequities present in workforce distribution
despite advances in staffing ratios, empowerment, and technology (AACON, 2020).

29

Figure 1
Supply and Demand Projections

Note. Adapted from Supply and Demand Projections of the Nursing Workforce: 2014–2030 by
the National Center for Health Workforce Analysis, 2017.
(https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/nchwa-hrsa-
nursing-report.pdf). Copyright 2017 by the U.S. Department of Health and Human Services.
Adapted from Confronting the nursing shortage by L. L. Workman, 2021. Nurse Key.
(https://nursekey.com/confronting-the-nursing-shortage). Copyright 2021 by Nurse Key.

As the nursing shortage threatens almost all European countries, many developed nations,
such as the United Kingdom and the United States, have resorted to short-term foreign nurse
immigration (Ross et al., 2005; Zander et al., 2016). However, the immigration of highly skilled
foreign nurses, which historically complements versus displaces national labor in the United
States, poses the dual threat of creating dependency patterns for the sending nation and
30

postponing innovative strategies for staff development in the host nation, halting inter-nation
collaborative exchange (“Need for Green Cards,” 2008). Nurse employment disparities abound,
and vulnerable populations risk occupational institutionalization due to migration (McCauley,
2005). Globally, the multi-faceted causes of nursing shortage attributed to domicile and lifestyle
preferences, job stress and quality of work-life, workload and workforce composition, retirement
and burnout, and the impact of organizational change and altered management practices (Buchan
& Aiken, 2008; Duffield & O’Brien-Pallas, 2003; Workman, 2021).
Overview of Diversity, Equity, and Inclusion Issues for Nursing Shortage
Table 11 lists the conclusions of the NCSBN survey (2020). The U.S. RN population
comprises 80.6% White/Caucasian, 7.2% Asian, 6.7% African American, 5.6% Hispanic, 2.1%
two or more races, 0.5% American Indian/Alaskan Native, and 0.4% Native Hawaiian/Pacific
Islander. These percentages highlight that the progression of the nursing field has historically
faced diversity, equity, and inclusion challenges that contemporarily persist. Women enlisted in
the military were not given fully commissioned officer status until 1947 (Registerednursing.org).
Despite contract nurses - which included nuns, African Americans, and Native Americans -
being employed by the U.S. military as early as 1898, nursing was historically a White, Non-
Hispanic male-dominated profession prior to the emergence of Florence Nightingale, who
changed the perspective of nursing to a female-only career, asserting that by nature, every
woman is a nurse (Robson-Mainwaring, 2021).
A Brookings Institution analysis reported by Frey (2021) of the 2021 U.S. population
reveals that 40% of the population identifies as people of color. However, a survey conducted by
Smiley et al. (2020) for the NCSBN and the Forum of State Nursing Workforce Centers reported
that 80.6% of the 2020 U.S. RN workforce was White/Caucasian, with only 19.4% from
31

minority backgrounds. Consequently, although minority RNs are more likely than their White
counterparts to pursue a Bachelor of Science (BSN) or higher degrees in nursing, according to
the 2008 National Sample Survey of Registered Nurses (HRSA, 2010), the AACN’s annual
survey reports that the 2021 U.S. full-time nursing school faculty had only 19.2% from minority
backgrounds. Regarding gender, men represented 9.4% of the 2020 U.S. RN population and only
7.4% of the 2021 U.S. full-time nursing school faculty (HRSA, 2010; Smiley et al., 2020).
Despite nurses of color recognizing the need to pursue higher levels of nursing education beyond
entry-level, the need to attract diverse nursing students and recruit more male and minority
faculty from diverse populations exacerbates.

Table 11
2021 U.S. Registered Nurse Population
Subject area % of U.S. RN population
White/Caucasian 80.6%
Asian 7.2%
African American 6.7%
Hispanic 5.6%
Other 2.5%
Two or more races 2.1%
American Indian/Alaskan Native 0.5%
Native Hawaiian/Pacific Islander 0.4%

Note. Adapted from “The 2020 National Nursing Workforce Survey” by R. A. Smiley, C.
Ruttinger, C. M. Oliveira, L. Hudson, R. Allgeyer, K. A. Reneau, J. H. Silvestre, & M.
Alexander, Journal of Nursing Regulation, 12(S1), S1–S96. (
https://www.journalofnursingregulation.com/article/S2155-8256(21)00027-2/fulltext)

32

Overview of the Pathways to Nursing Licensure
Table 12 lists the levels of nursing practice. The levels of nursing practice available for
career mobility vary in score and years of professional training. There are five levels of nursing
practice: the certified nursing assistant (CNA), the licensed practical nurse or licensed vocational
nurse (LPN/LVN), the RN, the ADN nurse, and the Bachelor of Science in Nursing (BSN) nurse.
While the levels of nursing practice are not mutually exclusive, gains in the scope of practice
occur with each advance in the level of nursing practice earned.

Table 12
Levels of Nursing Practice with Years of Nursing Training and Degree Obtained
Level of nursing practice Years of nursing education
CNA 5 weeks of nursing training
LPN/LVN 1 year of nursing training
RN 2 years of nursing training
ADN 2 year of nursing training and associate degree earned
BSN 4 years of nursing training and bachelor’s degree earned

Note. Routes to nursing licensure adapted from NursingProcess.org.

33

The typical, sequential advancement trajectory to nursing workforce entry from CNA to
BSN first involves CNA licensure. Completion of a CNA program, usually 5 weeks, is state
mandated through board testing and inclusion in the state Certified Nurse Assistant Registry for
one’s domicile (Coastal Alabama Community College, 2022). LPN training would follow for
one year of additional nursing education and passing the NCLEX-PN examination to receive a
certification or diploma. To advance from CNA to LPN, one should have a high school diploma
or a GED certification. Two pathways exist to gain RN licensure: a 1-year LPN to RN bridge
program or a 1-to-2-year LPN to ADN/RN program. Licensure as an RN requires passing the
state licensure examination, the NCLEX-RN. An ADN requires additional core credits above the
RN certification, allowing entry into nursing faster than a BSN but with fewer advancement
opportunities. Many nursing managerial positions require BSN-level candidates.
The BSN Degree is a 4-year degree for traditional high school student entry or a 1-to-2-
year career advancement trajectory for the RN or ADN, dependent upon the program chosen and
pre-requisite classes completed before program entry, granted by passing the NCLEX-RN
examination. The BSN focuses upon deep knowledge domains in nursing, science, leadership,
and management and is broader in the scope of practice for advanced procedures under a
doctor’s supervision and ability to delegate using nursing management than the ADN Degree.
The National Council of State Boards of Nursing regulates the NCLEX-PN for LPN or LVN and
the NCLEX-RN for RN, ADN, and BSN nursing licensure (NCSBN, 2022).
Hourly Salary and Implications
Table 13 lists the hourly and yearly salary averages for nurses compared to the minimum
wage based on entry-level new-graduate pay rates, which do not include overtime pay. The 2022
Bureau of Labor lists hourly salaries for the designation of nursing practice
34

(NursingProcess.org). The 2022 average federal minimum wage listed varies by state
(usafacts.org). All nursing salaries vary with the state of residence, the state of nursing licensure,
the nursing position acquired, employer benefits, experience levels, type of care given, and the
nursing specialization. Elm Community College grants CNA, LPN, RN, and ADN nursing
licensure.

Table 13
Nursing Hourly and Yearly Salaries by Designation
Level of nursing practice Hourly salary Yearly salary
Minimum wage $7.25 $15,080
CNA $15.41 $22,750
LPN/LVN $17.10 $35,570
RN $36.30 $54,790
ADN $24.65 $51, 280
BSN $40.50 $56,220

Note. Nursing Hourly and Yearly Salaries by Designation adapted from Salary section by
Nursingprocess.org, 2023. Copyright 2023 by NursingProcess.org

35

Economic Impact of ACT 18 Score Attainment for Nurses
The economic impact of ACT 18 attainment has far-reaching effects concerning achieved
levels of nursing licensure and the subsequent financial merits gained by the advancement of
nursing licensure from CNA to BSN. Nursing students from lower socioeconomic status or
marginalized communities may seek early entry into the nursing workforce, thus focusing on the
minimum wage to LPN or LVN nursing entry route. Many programs catered to BIPOC
communities at the community college level provide financial incentives to pursue LPN or LVN
nursing licensure as an expedited entry pathway to the nursing profession to increase the nursing
workforce while steadily decreasing the nursing shortage. Historically, the misalignment has
produced adverse educational effects for minimum wage earners enrolled in LPN or LVN
programs. Local cooperating agencies and administrators of community college nursing
programs have disagreed regarding the breadth and depth of clinical nursing experiences
(Grippando, 1974; Holzer, 2018). The following section presents 10-year net benefit
comparisons considering ACT 18 score attainment, nursing licensure pathways, and earning
potential.
10-Year Net Benefit Comparisons
Table 14 lists the net benefit comparisons for the varying pathways to nursing entry. An
asterisk (*) designates pathways requiring ACT 18 score attainment. The 10-year net benefit
comparisons assume an Unsubsidized or PLUS loan rate of 6.28% (Calonia, 2022). Nursing
salary increases ranged from an average of 1.3% per year from 2008 to the middle of 2014, with
a 2017 Bureau of Labor Statistics inflation rate of 2.6% (Stinger, 2017).

36

Table 14
Net Benefit Comparisons
Assumptions:

Annual inflation: 2.60%

Discount rate: 6.28%

Net Benefits Per Nurse Minimum Wage to CNA
Yearly Salary Increase $15,080 to $22,750
10-Year Net Benefit $86,326
Net Benefits Per Nurse Minimum Wage to LPN
Yearly Salary Increase $15,080 - $35,570
10-Year Net Benefit $230,617
Net Benefits Per Nurse Minimum Wage to RN*
Yearly Salary Increase $15,080 to $54,790
10-Year Net Benefit $446,927
Net Benefits Per Nurse Minimum Wage to ADN*
Yearly Salary Increase $15,080 to $51,280
10-Year Net Benefit $407,433
Net Benefits Per Nurse CNA to LPN
Yearly Salary Increase $22,750 to $35,570
10-Year Net Benefit $144.285
Net Benefits Per Nurse CNA to RN*
Yearly Salary Increase $22,750 to $54,790
10-Year Net Benefit $360,612

Net Benefits Per Nurse CNA to ADN*
Yearly Salary Increase $22,750 - $51,280
10-Year Net Benefit $321,103
Net Benefits Per Nurse LPN to RN*
Yearly Salary Increase $35,570 - $54,790
10-Year Net Benefit $216,327

Net Benefits Per Nurse LPN to ADN*
Yearly Salary Increase $35,570 - $51,280
10-Year Net Benefit $176.809

Note. * Designates pathways requiring ACT 18 score attainment

37

Overview of Self-Efficacy and Other Psychological Factors
Figure 2 provides a conceptual graphic of the Belle Obsidian Principle (SCHOOLS,
2021), which examines the internal and external psychosocial factors experienced by CCAPNS
that may decrease their individual ACT 18 score attainment rates. Researchers such as Olsen
(2017) recognized that high attrition rates in ADN programs contribute to the nursing shortage,
occasioning hardships for students, families, faculty, colleges, and taxpayers. The failure to
obtain a score of 18 on the ACT poses a barrier for CCAPNS that increases nursing program
attrition rates, as attaining a score of 18 on the ACT is an admission criterion related to ADN
program success and nursing student program advancement and completion.

Figure 2
The Obsidian Principle

Note. From Belle obsidian principle by V. Belle, 2015. Copyright 2015 by Valencia Belle.
38

CCAPNS’ inability to attain a score of 18 on the ACT poses a threat to their safety and
well-being according to Maslow’s Hierarchy of Needs (Maslow, 1943), inhibiting their ability to
care for themselves in ways that result in economic advancement and stability per Orem’s self-
care theory (Wagnild & Rodriguez, 1987). The inability to care for themselves with stability
leads to a family system breakdown from caregiver role strain per Bowen’s family systems
theory (Brown, 1999), occasioning systemic psychological distress and physical illness. By
implementing the ideology of the Comer School Development Program (Anson et al., 1991),
aligned with the tenets of consensus, collaboration, and no-fault when addressing the lack of
ACT 18 scores, community colleges could implement SCHOOLS as a programmatic portion of
their nursing school plan of study to increase ACT 18 score attainment levels to advance
CCAPNS admission to NSUD, as many CCAPNS are admitted to community college with
remediation due to sub-ACT 18 scores. By enhancing access to high-quality, cost-effective ACT
preparation using SCHOOLS in the community college nursing school plan of study, CCAPNS’
flow could be heightened by increasing access and decreasing advancement barriers, according
to Csikszentmihalyi’s flow theory (Beard, 2015). Ultimately, these psychosocial factors related
to ACT 18 score attainment failure affect CCAPNS’s self-efficacy.
Bandura (1997) defined self-efficacy as agency. CCAPNS who do not earn a score of 18
on the ACT might develop agency challenges, feeling little or no ability to exert control over
their essential life elements nor the motivation to enact changes from feedback received through
reciprocal interactions, essential tenets of self-efficacy (Bandura, 1997). Researchers have found
that nursing program attrition is associated with low self-efficacy and self-esteem. Bryer et al.
(2013), utilizing a descriptive correlational design and a nonprobability convenience sample of
first-semester ADN students, indicated self-esteem as significantly associated with student
39

attrition with data gathered using the Rosenberg Self-Esteem Scale, the General Self-Efficacy
Scale, and the Holmes and Rahe Social Readjustment Rating Scale. Thus, self-efficacy stands
empirically among the strongest and most consistent predictors of college students’ success
(Richardson et al., 2012).
Nursing Faculty Shortage Affects CCAPNS Self-Efficacy Through Advisement Limitations
The increased nursing shortage rate reflects the increased nurse faculty shortage limiting
adequate CCAPNS advisement regarding the routes to RN licensure. Nurse faculty’s knowledge,
education, and experience are used as human capital assets to educate new nurses (Kowalski &
Kelley, 2013). The limited number of nurse faculty has decreased student enrollment and
produced a decline in nurse graduates (Byrne & Martin, 2014n). Factors affecting nurse faculty
shortage include a decrease in the number of nursing professionals desiring to enter the nursing
faculty, insufficient teaching facilities, a decrease in the number of clinical sites, and an overall
decrease in the availability of qualified nurse faculty (Byrne & Martin, 2014). Additionally,
colleges and universities struggle to hire and retain nurse faculty due to salaries that are non-
competitive, clinical and classroom demands that are unreasonable, and clinical practice to
promotion and tenure requirements that are obscure, threatening nursing education, nursing
practice, and the entire nursing profession (Byrne & Martin, 2014). Solutions to increase nurse
faculty shortage include improved clinical nursing methods, enhanced instructional design for
nurses transitioning into nursing faculty roles, and increased salaries.
Summary
This dissertation’s problem of practice focuses on the essential role nursing education can
have in increasing ACT 18 score attainment rates to decrease nursing shortage rates by
implementing ACT test preparation in the nursing school plan of study. The inability to advance
40

to NSUD has far-reaching implications, affecting psychosocial and emotional health. CCAPNS
face impediments in gaining higher degrees in nursing that limit their wage-earning potential,
altering their career and wealth trajectory. Participation in the SCHOOLS ACT preparation
program could increase ACT 18 score attainment rates, ultimately increasing the diversity of the
nursing workforce. A detailed description of the methodology used to evaluate the effectiveness
of SCHOOLS follows.

41

Chapter Three: Methodology
This dissertation aimed to evaluate SCHOOLS to learn more about the program’s
effectiveness in increasing ACT 18 score attainment rates for CCAPNS. The dissertation also
assessed participants’ self-efficacy, program satisfaction, and perceptions of usefulness, drawing
on the Kellogg logic model program theory approach (W. K. Kellogg Foundation, 2004).
Chapter Three provides an overview of the dissertation’s evaluation questions, methods, data
sources, indicators, participants, instrumentation, and the timing and sequence of data collection
activities.
Evaluation Questions
This study focused on four evaluation questions:
1. To what extent are CCAPNS knowledgeable about the ACT preparation practices and
test processes?
2. To what extent does the ACT preparation program influence the test self-efficacy of
CCAPNS?
3. What are the perceptions of CCAPNS regarding the usefulness of the ACT
preparation program and its components?
4. To what extent is the SCHOOLS ACT preparation program effective in increasing
CCAPNS’ ACT 18 score attainment rates?
Overview of the Design
I used a mixed-methods survey and archival records data for analysis. The mixed-method
survey analyzed the responses of recent program completers from November 2022 to April 2023
after the IRB approval on November 2, 2022. Archival records data analyzed program
completers from January 1, 2018, to October 31, 2022. Survey results and records data were
42

analyzed to assess CCAPNS’ self-efficacy, program satisfaction, and perceptions of usefulness
for SCHOOLS. Table 15 provides an overview of data sources.

Table 15
Data Sources
Evaluation questions Data sources/indicators
To what extent are CCAPNS knowledgeable about the
ACT preparation practices and test processes?
Program records, surveys
To what extent does the ACT preparation program
influence the test self-efficacy of CCAPNS?
Surveys
What are the perceptions of CCAPNS regarding the
usefulness of the ACT preparation program and its
components?
Surveys
To what extent is the SCHOOLS ACT preparation
program effective in increasing CCAPNS’ ACT 18
score attainment rates?
Program records, surveys

43

Survey 1
A mixed-methods survey measured CCAPNS’ perceived self-efficacy gains and
perceptions regarding the program’s usefulness. Surveys were appropriate because they were
used to measure the attitudes of program completers in a convenient, economical way, with a
rapid turnaround time for data collection (Creswell & Creswell, 2018). Surveys with open-ended
forms of data allowed participants to freely share ideas without the constraints of predetermined
scales or instruments (Creswell & Creswell, 2018).
Archival Records Data
Archival records data sources used program documents. SCHOOLS used three
documents to capture data. These documents are the SCHOOLS Student/Parent Contract, the
SCHOOLS and JEM Evaluation Form, and the SCHOOLS Demographic Form. Collectively, the
forms included information regarding participants’ age, program completer status, gender,
race/ethnicity, year of high school graduation, previous medical certifications, community
college enrollment status, zip codes, last grades in math and science, knowledge of ACT test
practices and processes (ACT test registration, test questions per subject area, and test scoring),
most and least valuable program aspects, placement of program within NSUD, impact questions,
previous ACT attempts, ACT pre-mock and post-mock composite ACT scores from program
completion, satisfaction rates, self-efficacy rates, and perceptions of overall program and
components usefulness rates, ACT 18 score attainment rates, NSUD application rates, and
NSUD admission rates.
Research Settings
Table 16 lists the demographic profile of Elm Community College. Elm Community
College is in the Southeastern United States with more than 100 programs and pathways,
44

servicing 7,000–10,000 community college students across 5,000–9,000 miles of geography.
Elm Community College has a strong academic transfer rate in Alabama’s Statewide
Articulation Reporting (STAR) System, coordinating transfer among 2- and 4-year public
Alabama colleges and universities. The Elm Community College Division of Instruction and
Workforce Development provides education, training, workshops, and customized onsite
industry and business problem-solving technical assistance, with more than 40% males, more
than 50% females, and more than 5% veterans. Elm Community College has a minority
enrollment of more than 50%, exceeding the Southeastern U.S. states’ average of 39%.
SCHOOLS at Elm Community College services 100 nursing students yearly, with demographics
of <60% White, <30% Black, and <10% Other or Mixed Races (SCHOOLS Program Records,
2018–2022).

45

Table 16
2021 Elm Community College Demographics
Race % of enrollment
White/Caucasian 56
African American 36
Other 3.7
Two or more races 1.0
Asian 0.9
Hispanic 0.2
American Indian/Alaskan Native 0.3
Native Hawaiian/Pacific Islander 0.08

Note. Adapted from 2021 Elm Community College Fact Sheet by Elm Community College,
2021.

The Researcher
I am a female BIPOC, Ed-Tech entrepreneur who owns an ACT preparation company
that raises ACT scores as a matter of social justice to eradicate inter-generational poverty from
student loan debt. Concurrently, I am also a Black female BSN RN in the Deep South, a region
of the United States where most young aspiring Black females are tracked disproportionately
toward LPN licensure due to low ACT scores on community college pre-nursing school entry. I
was raised by a Black female BSN RN nurse educator who founded an LPN program during
segregation in the Deep South. My informal nurse training from birth by my grandmother was
filled with celebrations, expert-to-novice nurse skill attainments, and aspirations fueling the
possibility of unlimited higher degrees in nursing to be attained despite systemic racial
46

inequities. However, my formal nurse training was primarily received from White northeastern
U.S. female nurse educators in ways that negated my presence existentially and contradicted my
essence culturally. I became a nurse educator to instill the possibility of the promise of ACT 18
score attainment and the probability of passing nurse board exams for nurse licensure gain into
the hearts of little Black girls in the Deep South like me, even if they did not have my
grandmother’s legacy to pattern themselves after.
Although I code-switch well between serving as a nurse educator and an ACT test
preparation provider, I am not a fan of the othering (Omi & Winant, 2015) that so often occurs
from White nurse educators concerning advancing minorities and the marginalized through
matriculation while attaining community college nursing degrees. Early in my nursing career, I
resolved that I could not adequately address the centuries-old, wicked problems in typical
community college institutional structures that were fueled by power dynamics, subjugation, and
segregation. The concrete of cynicism had been poured instead of the erection of needed brick-
and-mortar test preparation facilities from national U.S. vendors, limiting my ability as a
traditional nurse educator to use my superpower of hope to overcome ACT 18 score attainment
barriers. I had to learn how to strategically guide my CCAPNS roses in growing through the
cracks in the concrete I made without damaging their grit petals. For more than 17 years, I have
been laboring in my test preparation garden, watering the seeds of CCAPNS nursing excellence I
saw, many of whom had been stifled with limited growth by the weeds of previous ACT 18
attainment failures.
I am so passionate about ACT 18 score attainment failure and its implications for
CCAPNS, especially BIPOC female CCAPNS, that I developed a conceptual graphic to attempt
to understand the complexities of the phenomenon I observed each semester when CCAPNS
47

applied for NSUD without their ACT 18 scores or the social capital to gain them. My formal and
informal nurse training regarding sexism, racism, and colorism as a Black female nurse allowed
me to view the stress of ACT 18 score attainment failure and its affiliated caregiver role strain
from a discerning lens ranging from subjugation to potential domination from societal norms.
My social capital (Yosso, 2005) gained from attending prestigious universities and family
pedigree could have skewed my findings. Although my social capital is valuable, it is
expendable, and pales compared to the brevity of financial inequities faced by BIPOC and
marginalized students while pursuing community college nursing licensure. I choose to use my
social capital to buy degrees on the borrowed experiences my educational accomplishments have
afforded, securing internships and scholarships through professional and personal connections
for as many BIPOC and marginalized CCAPNS as I can encounter, opening new worlds of
opportunity that, sadly for them, frequently only mentor referral and athletic prowess can afford.
The strength of my knowledge is experiential, intuitive, and medical. The
intersectionality of my race, gender, socioeconomic position, professional experience, and
geographic location affords realized bias and weakness in my research. I am dually a director and
a provider of ACT preparation services, which creates questions, tensions, and contradictions for
me attempting to inquire about best practices for the problem of practice.
I identify with the privilege axes of Educationalism and Classism. The power of my
privilege could alter my perspective of the complexity of background differences from culture
and contextual influences (Kezar, 2000). I have not knowingly experienced being denied the
benefits of a meritocracy based on gender, race, or color from closed competitions inhibited by
gatekeeper behavior (Sacks, 2015). My inherent bias may exist, posing internal reliability and
validity threats. Mitigating these issues requires purposeful reflection and thoughtful interjection
48

of well-constructed checks for the transferability of findings (Merriam & Tisdell, 2016). When
consciously aware, my biases were transparently communicated after careful reflexivity to not
skew the results interpreted from a biased predetermined experiential stance (Creswell &
Creswell, 2018). Hopefully, my attempts to share authentically with transparency the strain of
the duality I experience between my privilege and purpose adequately present my struggle with
bias, which might have affected this study’s design and findings (Merriam & Tisdell, 2016).
Participants
The survey was administered to CCAPNS program completers for either the 2-week or 5-
week modality of the SCHOOLS ACT test preparation at Elm Community College over 6
months. The program offered 2-week (online) and 5-week (onsite and online) versions. After
each cycle, all CCAPNS program completers received an invitation to take the survey. Based on
previous rates, the estimate of completers for each 2-week cycle was 10, and each 5-week cycle
was 10. Participants received an invitation to complete the survey online from the Elm
Community College Dean of Instruction. The invitation indicated that the survey was being
conducted as a part of a dissertation in practice. An anonymous survey link was emailed once
consent to participate was established and inclusion criteria verified.
Inclusion criteria for this study included CCAPNS enrolled in Elm Community College
seeking ACT 18 score attainment to advance to NSUD. Participants were adults aged 18 or
older, able to enter clinical nursing rotations upon advancement to NSUD, and ready to enter the
nursing workforce as registered nurses after passing the NCLEX-RN examination. Those who
did not complete the SCHOOLS ACT test preparation intensives were also excluded from
participation.

49

Archival Program Records Data Pre-Qualification Eligibility Screener Criteria
A total of 1,392 CCAPNS served as the population for the archival program records data.
Data from January 1, 2018, to October 31, 2022, were included. A random sample of 417
individual records was extracted for this study. All CCPANS in the sample were screened using
the same three inclusion criteria as the mixed-methods survey: 18 years of age or older,
participation in either a 2-week or 5-week ACT preparation program and completion of their
enrolled program. As the 2-week preparation program course was not offered until 2022, all 417
participants screened attended a 5-week SCHOOLS ACT preparation program and were program
completers (SCHOOLS, 2021).
Instrumentation
The anonymous survey included the following. The survey had three pre-qualification
eligibility screening questions, five demographic questions, eight usefulness questions, 28
knowledge questions, 16 self-efficacy questions, eight satisfaction questions, and eight impact
questions. The 16 self-efficacy questions were adaptations of Bandura’s (2006) self-efficacy
scale relevant to the study of Evaluation Question 2. Open and closed-ended questions addressed
access, advisement, and assistance barriers possibly experienced by CCAPNS at Elm
Community College while striving for ACT 18 score attainment relevant to the study of
Evaluation Question 3. CCAPNS program satisfaction questions addressed Evaluation Question
3. The archival program records and survey results determining ACT 18 score attainment rates
examined Evaluation Questions 1 and 4.
Data Collection Procedures
Once the USC IRB provided approval, I forwarded the anonymous USC Qualtrics survey
to the Elm Community College Dean of Instruction for dissemination to all CCAPNS who were
50

recent SCHOOLS ACT test preparation intensive program completers who agreed to participate
in the survey for the study. CCAPNS recent completers received an introductory email from the
Elm Community College Dean of Instruction, including the invitation letter to participate in the
study. The letter of invitation included a description of the study, participant responsibilities for
study completion, and advisement that the anonymous survey should take approximately 10
minutes. I advised participants that completion of a SCHOOLS ACT test preparation intensive
was required. Study participants received no monetary incentives. The three pre-qualification
eligibility screener questions verified participants’ study eligibility, ensuring that CCAPNS were
18 or older and SCHOOLS ACT test preparation intensive program completers.
Validity and Reliability
Salkind (2014) operationalized reliability and validity in survey administration. Validity
refers to measuring what one aims to measure, while reliability deals with the consistency of
measurement with repeated measures (Salkind, 2014). Operationalizing constructs maintained
face validity prior to survey administration. Additional sampling and recruitment strategies to
increase reliability and maximize response rates, or the percentage of return rate, included
multiple CCAPNS contacts with pre-notifications, cover messages, email reminders,
personalized survey invitations (request for help) from the Elm Community College Dean of
Instruction (a credible source), assurance of anonymity and confidentiality, and online
administration with a pre-set deadline (Robinson & Firth Leonard, 2019).
Ethics
Once participants expressed interest in completing the survey, the Elm Community
College Dean of Instruction forwarded the anonymous survey. Each participant read and
reviewed the Information Sheet and completed the digital consent form attestation on USC’s
51

Qualtrics. After completing the survey, participants received a thank you email from the PI, a
reiteration of the participant’s consent, and permission to use their responses for data
disaggregation.
After the research, excerpts from the published dissertation study, which maintain the
participants’ confidentiality, were shared with Elm Community College administration,
including the Dean of Instruction, the Director of the Division of Workforce Development, and
the Dean of Nursing. All SCHOOLS demographic forms with demographic surveys and
associated participant documents were scanned and saved electronically with password
encryption. Password-encrypted cloud-based storage kept all electronic data. All hardcopy data
were stored in a locked cabinet only accessible to the researcher. All direct identifiers and the
key to codes used in the study in hardcopy and electronic documents were deleted and destroyed
upon completion of the study to protect the participant’s confidentiality.

52

Chapter Four: Results
Chapter Four contains the results and analyses of the mixed-methods survey and archival
program records data used to answer the dissertation’s four research questions. This
dissertation’s purpose was to evaluate SCHOOLS to learn more about the program’s
effectiveness in increasing ACT 18 score attainment rates for CCAPNS through assessment of
CCAPNS’ self-efficacy, program satisfaction, and perceptions of usefulness, drawing on the
Kellogg logic model program theory approach (W. K. Kellogg Foundation, 2004). The four
research questions for the dissertation were:
1. To what extent are CCAPNS knowledgeable about the ACT preparation practices and
test processes?
2. To what extent does the ACT preparation program influence the test self-efficacy of
CCAPNS?
3. What are the perceptions of CCAPNS regarding the usefulness of the ACT
preparation program and its components?
4. To what extent is the SCHOOLS ACT preparation program effective in increasing
CCAPNS’ ACT 18 score attainment rates?
Recent program completers for SCHOOLS ACT test preparation intensives held from
November 2022 to April 2023 were administered surveys after IRB approval on November 2,
2022. Archival records data from January 1, 2018, to October 31, 2022, were analyzed for
program completers. Survey results and records data assessed CCAPNS’ self-efficacy, program
satisfaction, and perceptions of usefulness for SCHOOLS. In addition, observations were
performed in natural settings, including a review of the nursing school’s webpage and social
media sites.
53

Participants
Table 17 details the number of survey respondents who were program completers and the
modality of the SCHOOLS ACT preparation program they chose. Thirty-nine participants
completed the survey. Twenty-five participants, or 72.22%, completed the 5-week intensive,
while 10 participants, or 27.78%, completed the 2-week refresher intensive. Four participants did
not answer the question.

Table 17
ACT Preparation Program Intensive Participation
ACT preparation intensive Number of participants Percentage of participants
5–week 25 72.22%
2–week 10 27.78%

54

Demographics
Demographics for the 39 survey respondents and 417 record data review participants
follow. Survey participant demographics include gender, race/ethnicity, high school graduation
year, medical certification, and community college enrollment status. Demographics for archival
records data review participants include gender, race, zip code, and last grade in math and
science.
Survey Participants
Gender and Race/Ethnicity
Table 18 lists the gender, and Table 19 lists the race of the survey respondents. Most
(83.33%) survey respondents identified as female, while 16.67% identified as male. Of the 30
who answered the question about race/ethnicity, 63.33% were Black, 20% were mixed race,
13.33% were White, and 3.33% were Asian. Nine participants did not answer the questions
regarding gender or race/ethnicity.

Table 18
Gender
Gender Number of participants Percentage
Female 25 83.33%
Male 5 16.67%

55

Table 19
Race/Ethnicity
Subject area Number of survey
respondents
Percentage
Black 19 63.33%
Mixed (two or more races/ethnicities) 6 20.00%
White 4 13.33%
Asian 1 3.33%

Year of High School Graduation
The majority of survey respondents graduated between 2010 and 2020. Specifically,
44.85% graduated between 2010 and 2020, 20.7% between 2020 and 2030, 17.25% between
2000 and 2009, 13.8% between 1990 and 1999, and 3.45% graduated in the 1970s. Nine
respondents chose not to respond to this question.
Medical Certifications
More than half of the 39 survey respondents (79.31%) indicated they obtained a previous
medical certification. Medical certifications included seven CNAs, one first responder/CNA, five
Phlebotomists, six LPNs, three diploma RNs, and one dialysis tech. Six survey respondents
(20.69%) had no medical certification. Ten did not respond to this question.
Community College Enrollment
At the time of the survey, the majority of survey respondents (64.29%) indicated they
were not enrolled in community college. In addition, 35.71% indicated that they were enrolled in
community college. Eleven survey participants did not answer the question.

56

Archival Program Records Data Review Participants
Gender and Race/Ethnicity
Table 20 lists gender frequencies, and Table 21 lists the race of the 417 archival program
records data review participants chosen through random assignment. Sixty percent of the
archival program records data review participants identified as female and 40% as male.
Participants’ races were Black (65%), White (33%), Hispanic/LatinX (1%), and mixed race
(1%).

Table 20
Gender of Participants from Archival Program Records Review Data
Gender Participants (N = 417)
F %
Female 251 60
Male 166 40

57

Table 21
Race/Ethnicity of Participants from Archival Program Records Review Data
Race Participants (N = 417)
F %
Black 271 65
White 138 33
Hispanic 4 1
Mixed 5 1

Participant Zip Codes
The archival program records data review included participant zip codes extracted to
establish socioeconomic status in relation to poverty status. The zip codes were checked against
Alabama’s lowest poverty zip codes list. Alabama’s 2021 Small Area Income and Poverty
Estimates, conducted by the U.S. Census Bureau, had 16.3% of its populace, or 800,848 of
4,920,612, listed as the number in poverty (U.S. Census Bureau, 2021). Twenty-six archival
program records data review participants’ zip codes were identified, with 15.4% falling within
Alabama’s 50 lowest-poverty zip codes (UnitedStatesZipCodes.org, 2022).
Last Grades in Math and Science by Participant Self-Report: Archival Records Review Data
Table 22 lists the percentages of archival program records data review participants’ last
grades in math and science. Of the 417 participants, 93 answered both questions about these
grades. The results were that 37.6% reported math grades as A, 36.6% as B, 21.5% as C, and
4.3% D. For science, 36.6% reported A, 43% reported B, 19.4% reported C, and 1.1% reported
D.

58

Table 22
Archival Data Program Records Review Participant Responses to Last Grade in Math and
Science
Grade Math
participants
Percentage Science
participants
Percentage
A 35 37.6% 34 36.6%
B 34 36.6% 40 43%
C 20 21.5% 18 19.4%
D 4 4.3% 1 1.1%

Findings
Findings were organized by the four research questions. The findings evaluated the
effectiveness of the SCHOOLS ACT preparation program in increasing rates of CCAPNS’
knowledge about ACT preparation practices and test processes, test self-efficacy, overall
program perceptions and usefulness of program components, and ACT 18 score attainment. The
findings included data from both the survey and archival records.
Research Question 1: CCAPNS’ Knowledge About ACT Preparation Practices and Test
Processes
Survey data and program records revealed that completing a SCHOOLS ACT preparation
program increased CCAPNS’ fundamental and procedural knowledge of ACT preparation
practices and ACT test processes. Specifically, survey results from enrollment to completion of a
SCHOOLS ACT preparation program intensive revealed increased knowledge of test
registration, questions per subject area and overall, and scoring.
Research Question 1 was focused on determining the extent to which CCAPNS enrolled
in SCHOOLS were knowledgeable about the various aspects of the ACT. The survey included
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knowledge questions that asked CCAPNS to think back to the beginning of the program and then
to think back to the end of the program as to whether they knew how to do each of a set of
actions before the program started and they took the ACT preparation course versus after
completing the program. CCAPNS were given the answer choices of yes, partially yes, or no.
Knowledge of ACT Preparation Practices at the Beginning of the Program
Findings from this dissertation revealed that participation in SCHOOLS increased
knowledge of ACT preparation practices, specifically regarding registration, questions based on
subject area and overall, and test scoring. For CCAPNS to succeed in taking the ACT, they must
first have a fundamental understanding of ACT preparation practices. This understanding
includes procedural knowledge regarding the ACT and its principle in NSUD entry.
Test Registration
Table 23 details a comparison of survey respondents’ percentages of their knowledge
questions responses before and after program completion. Survey questions assessed ACT test
registration knowledge of how to register for the ACT, how to upload their photo to complete
ACT registration, how to pay for the ACT, how to obtain a free ACT fee waiver voucher, and
how to prepare for the ACT. Survey respondents were provided with five questions regarding
their general understanding of how to register for the ACT prior to and after program
completion. They were asked to select from three options: yes, partially yes, and no.

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Table 23
Percentages of Responses to Questions Regarding ACT Registration
Survey questions Before program
Yes %
After program
Yes %
How to register for the ACT? 31.03% 93.10%
How to upload photo to complete ACT
registration?
17.86% 75.68%
How to pay for the ACT? 20.69% 86.21%
How to obtain a free ACT fee waiver
voucher?
3.45% 79.31%
How to prepare for the ACT? 3.45% 93.10%

Survey respondents indicated that, prior to program enrollment, most lacked test
registration knowledge. Specifically, at program entry, 31.03% of CCAPNS knew how to
register for the ACT, 17.86% knew how to upload their photo to complete registration, 20.69%
knew how to pay for the exam, 3.45% knew how to obtain a fee waiver voucher, and 3.45%
knew how to prepare for the ACT. At program completion, 93.10% of CCAPNS demonstrated
knowledge of how to register, 75.68% knew how to upload their photo, 86.21% knew how to
pay, 79.31% knew how to obtain fee waiver voucher, and 93.10% knew how to prepare for the
ACT. These results indicate that the percentage of CCAPNS’ ACT test registration knowledge
increased.
In contrast to the survey respondents’ answers before enrolling in the test preparation
course, more than 75% indicated that they knew how to register for the ACT, how to upload their
photo, how to pay for the exam, how to obtain a fee waiver voucher, and how to prepare for the
ACT at program completion.
ACT Test Questions
Table 24 outlines CCAPNS’ knowledge questions responses for ACT test questions
before and after program completion. Survey respondents were asked five questions that
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determined their knowledge of ACT test questions based on each subject of the exam and overall
before beginning and after completing the ACT preparation program. The answer options were
yes, partially yes, and no. Survey respondents also responded to questions that asked how many
correct questions were needed to earn a score in each subject area and overall and how much
time they have to answer questions on the ACT.

Table 24
Percentages of Responses to Questions Regarding ACT Subject Area Questions
Survey questions (n = 29) Before program
Yes %
After program
Yes %
Correct questions needed to earn your score in each
subject area and overall?
13.79% 89.66%
How to answer questions in the English section? 10.34% 93.10%
How to answer questions in the math section? 10.34% 93.10%
How to answer questions in the reading section? 13.79% 93.10%
How to answer questions in the science section? 17.24% 92.59%
How much time do you have to answer questions on the
ACT?
17.86% 93.10%

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The majority of survey respondents lacked knowledge regarding the correct questions
needed to earn an ACT 18 score in each subject area and overall (13.79%) prior to enrolling in
the program. The participants demonstrated an increase in knowledge of how to answer ACT
questions in English, Math, Reading, and Science, as well as overall. In addition, they increased
their knowledge of how much time they had to answer questions. This increase indicated that
they did not understand the content or timing necessary to know how to answer questions before
completing their preparation program.
ACT Test Scoring
Table 25 presents survey respondents’ responses to questions regarding ACT test scoring
at the beginning and end of the program. Two of the survey questions asked survey if they knew
how to receive their ACT scores after taking the test and if they knew how to send the scores to
Elm Community College, with one question asking if they knew how the exam was scored. The
participants responded by answering yes, partially yes, or no.

Table 25
Percentages of Responses to Questions Regarding ACT Test Scoring
Questions
(n = 29)
Before program
Yes
After program
Yes
How to receive your ACT score? 27.59% 93.10%
How to send your score to ELMCC? 0% 65.52%
How is the ACT scored? 93.10% 89.66%

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Despite the majority of CCAPNS stating that they knew how the ACT was scored
(93.10%) at program entry, most lacked knowledge regarding the scoring process. They did not
know how to receive their scores (27.59%), and none (0%) knew how to forward these to Elm
Community College for NSUD application. In contrast, after program completion, the majority
(93.10%) of survey respondents indicated they knew how to register for the ACT and send their
scores. Program completers gained specific scoring process knowledge of how to receive and
forward their scores to Elm Community College. Program completers also retained their
previously held knowledge of how to register for the ACT.
From beginning to end, CCAPNS program completers gained fundamental and
procedural knowledge about the ACT preparation practices and test processes. Participation in
and completion of the SCHOOLS ACT preparation program changed the perceptions of
CCAPNS and Elm Community College stakeholders. Awareness of the need to address
knowledge deficits in three specific ACT testing elements was discovered: registration,
questions, and scoring.
Number of ACT Attempts with Results: Archival Program Records Review Pre-Course
Completion
About a third of archival program records data review participants (32.4%) had not taken
the ACT before course completion. Seventy-one of the 417 participants answered the questions
regarding the number of times they took the ACT and the results of their ACT attempts. Eleven
of the 71 respondents (15.5%) had attempted the ACT once. Thirteen (18.3%) had attempted it
twice. Eight (11.3%) had attempted it three times. Eight (11.3%) had attempted the ACT 4 times.
Three (4.2%) had taken it five times. Three (4.2%) had attempted it 6 times. One (1.4%) had
taken it seven times. Only one (1.4%) had attempted the ACT 10 times and had only two
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remaining opportunities to earn an 18, as ACT imposes a lifetime limit of 12 testing
opportunities (ACT, 2016).
The average ACT composite score first attempt was 19.3, with a range of 18 composite
score points. The average ACT composite score second attempt was 20.6, with a range of 15
composite score points. The average ACT composite score third attempt was 22, with a 13
composite score points range.
Research Question 2: CCAPNS’ Self-Efficacy
Research Question 2 focused on determining what type of influence participation in the
SCHOOLS ACT preparation program had on CCAPNS self-efficacy. The dissertation’s results
highlighted that CCAPNS initially lacked agency in following the necessary steps in registering
and studying for the ACT. CCAPNS also lacked confidence in correctly answering questions on
the English, Math, Reading, and Science sections upon program entry. Finally, CCAPNS
experienced increased confidence in their ability to exert control over scoring at least an 18 on
the ACT and their motivation to advance to NSUD from program entry to exit. A detailed
analysis of the findings follows.
Table 26 details CCAPNS’ responses to self-efficacy questions before and after program
completion. Six questions asked survey respondents to think back to both the beginning of the
program (before the program started) and the end of the program (after completing the program)
and rate their confidence in what they could do from 0 to 10, with 0 indicating could not do at all
and 10 indicating highly certain I can do. The six questions dealt with following the necessary
steps to register for the ACT, study for the ACT, answer questions correctly on the English,
Math, Reading, and Science sections, score at least an 18 on the ACT, and advance to NSUD.
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Table 26
Percentages of Responses to Questions Regarding ACT Self-Efficacy Scoring
Questions
(n = 29)
Before program
0–10
After program
0–10
Follow the necessary steps to register for the ACT? 1.54 8.71
Studying for the ACT? 1.67 8.63
Answering questions correctly on the ACT English
section?
1.79 8.75
Answering questions correctly on the ACT math
section?
1.92 8.46
Answering questions correctly on the ACT reading
section?
1.88 8.38
Answering questions correctly on the ACT science
section?
1.75 8.33
Scoring at least an 18 on the ACT? 1.83 8.88
Advancing to nursing school upper division? 1.63 8.25

Study participants stated that the SCHOOLS ACT preparation program increased their
confidence regarding the abilities and skills necessary to register and study for the ACT from the
beginning to the end of the program. CCAPNS reported post-program completion confidence
increases for answering questions correctly for the ACT English, Math, Reading, and Science
sections. These increases demonstrated an increasing sense of control by CCAPNS over the ACT
content tested, moving from feeling unable to complete the ACT at all to expressing high
certainty in their ability. Finally, CCAPNS reported confidence increases at program completion
to score at least an 18 on the ACT and advance to NSUD.
Research Question 3: Overall Program Perceptions of Usefulness of Program Components
and CCAPNS’ Satisfaction with the SCHOOLS ACT Preparation Program
Research question 3 focused on determining the usefulness of the SCHOOLS ACT
preparation program for CCAPNS through ACT preparation, examining CCAPNS’ perceptions
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of the usefulness of the overall program and its program components. Survey responses and
archival program records data addressed satisfaction questions, the environment, the most and
least valuable program aspects, and impact questions, with survey respondents’ responses
allowing for self-expression through additional comments. A detailed description of the
dissertation’s findings regarding CCAPNS’ perceptions of SCHOOLS’ usefulness and their
satisfaction with SCHOOLS follows.
CCAPNS Usefulness Perceptions of the ACT Preparation Program and its Components
Table 27 supports the usefulness of the components of the SCHOOLS program in
providing accessible resources that increased CCAPNS’ ACT 18 score attainment rates at Elm
Community College, reducing nursing shortage by enabling higher rates of NSUD application
and admission. At program completion, survey respondents rated the usefulness of eight program
components of SCHOOLS in helping them prepare to take the ACT from 0 to 10, with 0
indicating not useful to 10 indicating extremely useful. These program components included
welcome and orientation materials at program entry, Zoom class meetings, Google classrooms,
ACT preparation instructional videos, ACT practice tests, ACT practice test exemplars, Remind
apps, and weekly homework checks.

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Table 27
Survey Respondents’ Ratings of SCHOOLS Program Components
SCHOOLS program components
(n = 29)
Rating
0–10
Welcome and orientation materials prior to
the beginning of the program
9.18
Zoom class meetings 8.9
Google Classroom 9.0
ACT prep instructional videos 8.5
ACT practice tests 9.41
ACT practice test exemplars 9.82
Remind app 7.69
Weekly homework checklists 9.24

Note. Data from this study’s logic model Qualtrics survey results.

Study participants recognized the usefulness and accessibility of the SCHOOLS ACT
preparation program as an effective tool for NSUD program advancement. At program exit,
survey respondents provided additional comments about the program and its usefulness. One
survey participant gave high regard to the instructor, thanking her and saying, “I graduated and
passed boards from the tools I learned.” Another survey participant stated, “The program also
helped me with understanding the NCLEX testing process. I used the test-taking skills to help
me.” CCAPNS’ usefulness and satisfaction rates increased post-program, evidenced by themes
expressed as the least and most valuable program aspects for SCHOOLS.
Most Valuable Program Aspects
Survey questions inquired which program aspects respondents deemed most valuable to
enhancing their learning and preparation for the ACT and why. Twenty-nine (29) survey
respondents gave detailed descriptions of their personal evaluations of the valuable aspects of
SCHOOLS. Thematic analysis revealed four themes: the teachers, the learning environment, the
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ACT preparation intensive instructional components, and the test preparation information
techniques.
According to survey respondents, teachers were among the most valuable aspect of the
program. One stated, “Everyone was patient and helpful.” Another stated, “The instructors were
really nice and did a great job explaining things.” An additional respondent stated, “I did better
with in-person instruction.” A fourth stated, “The most valuable aspect for me was the test-taking
strategies and the encouragement from ALL the instructors.” A fifth noted, “The length of time
we had to study for the ACT. The teacher took her time answering the questions we didn’t
understand.” Others valued “Instructions by the teacher” and “Teacher interaction.”
The learning environment also played a valuable role in facilitating survey respondents’
learning and self-efficacy. One stated that “The learning environment” made the overall program
and its components valuable. A second valued the interaction made capable by the classroom
structure, stating, “I really liked the classroom structure. The interaction helped me to understand
better.” A third respondent valued the library environment, stating that “Learning in the library
with extra materials” was essential to promote learning.
The ACT preparation intensive instructional components were deemed valuable by
survey respondents. “The thorough yet compact structure of the course” was a value add for one,
stating, “I was time restricted, and it helped me accomplish my goal score.” Others mentioned
program components such as “practice questions, “the homework assignment,” and “videos.”
One survey participant valued the Remind app, stating, “The reminders were helpful.” Four
survey respondents specifically stated valuing “practice test/s.” Survey respondents also valued
the videos component, stating that “The videos were available whenever I wanted to watch
them” and that the “videos and directions on how to take the test” were helpful.
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Study participants valued the ACT test preparation information given. “Test-taking
strategy” was how one study participant described the value of the ACT test preparation
information given. This sentiment was echoed by others, stating that “test-taking strategies,”
“strategies on how to take the test,” and “the strategies given” were useful. One participant
stated, “I learned self-confidence in my test-taking skills. This was the key to my success on the
ACT!” A second study participant valued “Instructions on how to take the test. I had no idea how
to prepare for the test.”
Overall, study participants found the program and its components personally and
professionally valuable. One study participant stated, “Every part of it was needed for me.”
Another study participant stated that “All information was very valuable.” A final study
participant valued the overall program and its components, stating, “The whole experience was
amazing, and it prepared me for all standardized tests.”
Least Valuable Program Aspects: Survey Respondents
Responses to the questions regarding the least valuable aspect of the course paralleled
answers to the most valuable aspect questions regarding learning and preparation for the ACT.
One participant answered, “Everything was valuable.” Another answered similarly: “Every part
of this prep class was beneficial.” Lastly, two respondents lacked suggestions, stating, “I can’t
think of anything,” or offering no answer. Only one respondent replied negatively, stating, “I had
information overload.”
CCAPNS Perceptions of the Intended Nursing Program Curriculum Placement of SCHOOLS
The CCAPNS responded to questions regarding the intended Elm Community College
nursing school curriculum placement of the SCHOOLS ACT preparation program to best
support their ACT 18 score attainment efforts. Twenty-seven survey respondents assessed the
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placement of SCHOOLS at four possible delivery points: once students were admitted, during
the first semester of the nursing program, during the second semester of the nursing program, or
during the third semester of the nursing program when students apply to NSUD. Elm
Community College offers SCHOOLS during the third semester of the nursing program. The
majority of respondents (81.48%) stated that SCHOOLS should be administered as soon as
CCAPNS are admitted to Elm Community College.
Recommendations for Future Program Improvement: Survey Respondents
Survey respondents suggested three key areas for recommendations for future program
improvement. These three areas were the placement within the NSUD curriculum for the timing
of ACT test preparation, how to access the test preparation, and additional wrap-around services
for advisement before, during, and after the course to ensure course completion. Survey
participant responses for the three key areas follow.
Survey respondents gave recommendations for the future improvement of SCHOOLS.
Although some respondents (43.75%) had no recommendations, several denoted the need to
address the timing of test preparation, access issues, and wrap-around services needed.
Regarding the timing of the test preparation, one stated, “Start students to prepare in grade
school.” Another stated, “Students to be informed in junior high school” would be
recommended. A final respondent said, “I have nothing to compare this program to.” One stated
that “More advertising” was needed regarding access assistance. Another said to “offer a virtual
course.” A third wanted more “peer-to-peer evaluation.” Finally, regarding wrap-around
reminders and advisement services, one participant stated, “For me, the reminders were too
much, but it was beneficial for others.” Another stated, “They are doing an excellent job” with
CCAPNS contact. A third requested “more opportunities for one-on-one instruction!”
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Satisfaction Questions: Survey Respondents
Survey respondents expressed satisfaction with the SCHOOLS ACT preparation course,
expressing their feelings and positive responses as to why certain program components were
satisfying with specific examples. Six questions dealt with areas of overall and component
program satisfaction for SCHOOLS. These six areas were quality of the instruction provided in
the live Zoom meetings, quality of the instruction provided in the instructional videos located in
the Google Classroom, quality of the test preparation resources in the Google Classroom (ACT
preparation manuals, weekly homework checklists, ACT practice tests and exemplars, and
additional class materials), ease of navigation of the Google Classroom, and the time required for
the instructional team to respond to questions.
The participants responded positively to the assertion that enrolling in the overall
SCHOOLS program and its components was necessary to promote ACT 18 score attainment
success leading to NSUD advancement, with satisfaction expressed for the quality of instruction
that promoted learning and preparation for the exam. When asked which aspects of SCHOOLS
provided quality enhancing CCAPNS’ learning and ACT preparation, survey respondents stated,
“The instructors were really nice and did a great job at explaining things,” and “Everyone was
patient and very helpful.” They shared that their greatest satisfaction came from the quality of
interactions with instructors encouraging CCAPNS’s success. One respondent reported, “How
the instructors really wanted to see me succeed and gave great advice” as the most satisfying
aspect, while another added “one-on-one session with each teacher” as the most satisfying
program aspect.

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Environment: Survey Respondents
Survey respondents noted that the instructional environment played a role in their ACT
preparation. Critical aspects that fostered learning discussed by CCAPNS included the classroom
structure, the learning environment, and the instructional resources used for ACT test preparation
and practice. One participant stated, “I really liked the classroom structure. The interaction helps
me understand better.” Other respondents stated, “the learning environment” was essential,
including “the strategies given” and the “practice test.” Furthermore, survey respondents
considered the resources used throughout the program as key components, with one respondent
stating, “All the information was valuable.”
Impact Questions: Survey Respondents
Survey respondents responded to questions regarding which parts of the program
impacted them most. Three themes emerged from thematic analysis. When asked about the
program’s impact on them personally, participants shared that the teachers, the ACT preparation
intensive instructional components, and the ACT test preparation information techniques given
were the most impactful. Descriptions of these three emergent themes follow.
Survey respondents noted the impact of teachers. One stated that they enjoyed the “face-
to-face visits.” Another stated, “The teacher.” A third stated, “The teaching style. I did not feel
like a complete idiot during the course.” Finally, another responded, “The teacher’s (named
specifically) A.B.’s enthusiasm for teaching” was most impactful.
Intensive instructional components impacted survey respondents. Survey respondents
stated that “Videos” were impactful. One responded that the “videos I could watch at my chosen
time” were very helpful. Lastly, others responded that instructional components impacted “How
to take the test well,” providing “Information on how to master the test.”
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Test preparation information techniques given impacted survey respondents. Survey
respondents stated that “How to answer the questions from each section,” “The practice test,”
and “Information given by the teacher” were impactful. Several also stated that the “teachings
from Zoom” were impactful. Other responses that revealed the program’s impact on the survey
respondents included “instructional time,” “the knowledge gained through knowing how to
actually take the test,” and “taking multiple practice tests.”
Survey respondents described the program’s personal impact. One stated, “I particularly
enjoyed the interactions with others.” Another stated, “All of the instructional information and
practice tests were very helpful.” A final respondent expressed pleasure with the teacher’s
“enthusiasm for teaching.”
Survey respondents conveyed positive responses to SCHOOLS, expressing satisfaction
with the programs’ overall and component usefulness. They expressed satisfaction with the
program’s usefulness as a necessity to achieving the required ACT score for Elm Community
College NSUD admission. In addition, they expressed that enrolling in SCHOOLS was
personally impactful to reaching ACT 18 scores and advancing to NSUD.
Research Question 4: ACT 18 Score Attainment Rate Effectiveness
Research Question 4 focused on determining the extent to which SCHOOLS was
effective in increasing rates of CCAPNS’ ACT 18 score attainment and NSUD application and
admission. Archival program records data review revealed that completion of a SCHOOLS ACT
preparation intensive increased CCAPNS’ ACT 18 score attainment rates. Program completers
earned an average increase of five points when comparing their pre-mock to post-mock ACT
composite scores. The following section presents the results from the composite score attainment
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data, with an evaluation of ACT 18 score attainment, NSUD application, and NSUD admission
rates derived from survey responses and archival program records review.
Figure 3 presents program completers’ ACT mock composite score gains. During the
program, CCAPNS took two mock tests, with each of the 215-question tests given over a 4-hour
testing period to simulate the actual test. The pre-mock and post-mock tests used the same ACT
practice test, observing ACT composite scores as a repeated measure at multiple points in time.
The time points for repeated measure analysis for SCHOOLS were program entry, Week 1, and
the week of program exit (Week 2 or Week 5, depending on enrollment). Program completers
averaged a Week 1 pre-mock composite score of 17 and an average post-mock composite score
of 22.

Figure 3
ACT Mock Composite Score Pre-Intensive and Post-Intensive

Note. Adapted from an archival records data review by SCHOOLS.

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Results from the archival records data review and the mixed-methods survey revealed
that the SCHOOLS ACT preparation program effectively increased ACT 18 score attainment
rates for CCAPNS. Program completers’ post-mock ACT composite scores increased by 50% or
higher over their documented pre-mock ACT composite scores when beginning-to-end and
within-subject assignments were completed for the 39 mixed-methods survey respondents and
the 417 archival records data review participants. Finally, the CCAPNS’ ACT 18 score
attainment rate goal increased by over 50% for program completers of the mixed-methods survey
and archival record data review participants.
NSUD Application
Table 28 details survey responses regarding NSUD application. The question asked
whether participants had applied to NUSD. Nearly 70% (67.86%) of those who were program
completers and achieved an ACT 18 score applied to NSUD. Response options were yes, no, or
not yet.

Table 28
Survey Responses to NSUD Application
Have you applied to nursing school
upper division?
(n = 29)
Percentage
Yes 67.86%
No 25%
Not yet 7.14%

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NSUD Admission
Table 29 detailed survey participant responses regarding whether they had been admitted
to NSUD. More than half (53.5%) of program completers who achieved an ACT 18 score and
applied to NSUD were admitted. Response options were yes, no, and I don’t know.

Table 29
Survey Responses to NSUD Admission
Were you admitted to nursing school
upper division?
(n = 29)
Percentage
Yes 53.57%
No 32.14%
I don’t know 14.29%

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Overall Course Effectiveness in Raising ACT Scores
Program completers of the SCHOOLS ACT preparation program experienced ACT
composite score increases. Over 90% of survey respondents achieved ACT 18 score attainment.
The following discussion detailed the results for the overall effectiveness of SCHOOLS in
raising ACT scores.
ACT 18 Score Attainment: CCAPNS Participant Survey Responses
Table 30 presents rates of ACT 18 attainment for SCHOOLS program completers. More
than 90% (92.59%) of respondents who completed a SCHOOLS ACT preparation intensive
reached that score. The question asked whether they had attained a composite score of at least
18. Answer options were yes, no, and I don’t know.

Table 30
Survey Responses to ACT 18 Score Attainment
Have you attained a composite score
of at least an 18 on the ACT?
(n = 29)
Percentage
Yes 92.59%
No 7.41%

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Summary
Four key findings were derived from the analysis of survey data and archival program
records data. First, CCAPNS participation in SCHOOLS increased their knowledge of ACT
preparation practices and test processes. Second, completion of SCHOOLS ACT preparation
increased self-efficacy. Third, those who completed a 2-week or 5-week program intensive
perceived these as useful overall, with varying degrees of usefulness for specific program
components. Fourth, the SCHOOLS ACT preparation program demonstrated effectiveness in
increasing ACT 18 score attainment rates.

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Chapter Five: Impact and Recommendations
This dissertation addressed ACT 18 score attainment failure for CCAPNS that inhibited
NSUD advancement, prohibiting RN licensure and decreasing rates of diversity, equity, and
inclusion in the U.S. RN workforce, leading to a nursing shortage. The focus of the problem of
practice for this dissertation dealt with increasing rates of ACT 18 score attainment through ACT
test preparation embedded in community college ADN nursing program education. Chapter Five
discusses the dissertation’s findings and the role of test preparation embedded within community
college programs in increasing ACT 18 score attainment rates and strengthening the nursing
workforce.
Discussion of Findings
I made four broad observations from the study’s findings. First, survey data and program
records revealed that completing a SCHOOLS ACT preparation program increased CCAPNS’
fundamental and procedural knowledge of ACT preparation practices and test processes in three
areas: registration, questions per subject area, and overall test scoring. Second, although
CCAPNS lacked agency at program entry in registering and studying for the exam and lacked
confidence in answering its questions, program completers experienced increased confidence in
their ability to exert control over scoring at least an 18 and their motivation to advance to NSUD.
Third, survey responses and archival program records data review revealed that CCAPNS
expressed positive responses to the overall usefulness of the SCHOOLS program and its
components and satisfaction with the program’s personal impact at program completion. Fourth,
completion of a SCHOOLS ACT test preparation intensive increased ACT 18 score attainment
rates, NSUD application, and NSUD admission, with program completers averaging a 5-point
mock composite score increase. In addition, the overall findings resulted in three big takeaways:
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(a) a need to re-examine the service modalities of SCHOOLS, (b) a need to explore why
CCAPNS who successfully achieved ACT 18 score attainment still did not apply to NSUD, and
(c) a need to reposition the timing of the offering of SCHOOLS at Elm Community College.
Takeaway 1 is that there is a need to re-examine the service modalities of SCHOOLS
with consideration of the most useful program components. SCHOOLS is currently disseminated
at Elm Community College in either a 2-week or 5-week modality, onsite and online, with live
instruction given by SCHOOLS academic coaches. The survey respondents stated that the
teachers and the learning environment were two of the most valuable aspects of SCHOOLS.
However, when considering survey respondents’ usefulness rates of the program components,
those not requiring a live academic coach to be present to create the learning environment were
rated as the least useful. Access to the ACT preparation instructional components and test
preparation information techniques could be disseminated in a new modality, as CCAPNS also
valued these aspects. Neither of these two components requires live academic coach instruction.
This new modality could exclude the live Zoom class meetings, the recording of live
instructional videos, and the daily Remind app reminders, as these three components were rated
lower in usefulness.
Interestingly, CCAPNS program completers rated the Remind app reminders the lowest
for usefulness. This finding was unexpected. Feedback in the past suggested that participants
wanted external reminders to stay on task during their preparation intensives as their
environments lacked external authority figures for accountability to encourage course completion
if and when their internal motivation to persist waned.
Takeaway 2 is that there is a need for a more in-depth discussion with CCAPNS who
earned an ACT 18 score yet did not apply to NSUD. Interviewing a conveniently sampled focus
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group of CCAPNS program completers could add a nuanced understanding of this unexpected
dissertation finding. Program completers achieved an ACT 18 score at a rate of 92.59%.
However, only 67.86% of CCAPNS who earned that score applied to NSUD. More research is
needed to learn why CCAPNS are not seeking advanced nursing education.
Finally, Takeaway 3 is that there is a need to reposition the timing of SCHOOLS’
modality offerings. Findings indicate that 81.48% of CCAPNS desired to attend a SCHOOLS
ACT test preparation intensive during the first semester of the nursing program at Elm
Community College. The college offers SCHOOLS during the third semester. Findings from the
archival program record data review detailed that, entering the third semester of nursing school,
32.4% of CCAPNS had never taken the ACT. In comparison, other CCAPNS unsuccessfully
attempted ACT 18 score attainment from once (15.5%) to 10 times (1.4%). Allowing CCAPNS
to engage in test preparation during their first or second semester could allay the high rates of
unsuccessful attempts to earn the required score.
Recommendations
There are two recommendations from this program evaluation. First, I recommend
expanding SCHOOLS based on the program’s high effectiveness. This expansion could be for
two groups of students. Group 1 could consist of middle and high school students in the state
who need to earn national benchmarking levels of ACT composite scores to meet the new 2028
State of Alabama High School CCR Credentialing graduation requirements. Group 2 could be
CCAPNS enrolled in the state’s 24 community colleges with ADN programs who need an ACT
score of at least 18 to advance to NSUD. Second, I recommend revising the current 2-week and
5-week intensive modalities to develop a delivery method that does not require a live academic
coach for instruction. This new delivery method could be virtual, subscription-based, and
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composed of only the program components rated highest for usefulness by CCAPNS program
completer end-users.
Recommendation 1: Expand the Reach of SCHOOLS
Findings indicated that 92.59% of program completers attained an ACT 18 composite
score, suggesting that the program is highly effective at preparing test takers. Given this
effectiveness, I recommend that program managers consider opportunities to deliver the program
to more test takers in ADN nursing programs and middle and high schools. Score attainment
rates could increase through broader access to SCHOOLS for more CCAPNS, especially BIPOC,
LatinX, and first-generation college students.
There are 24 ADN programs in the Alabama community college system, ranging in
NCLEX-RN pass rates from 49.15% to 95.65% (ABN, 2021c). In 2021, CCAPNS student
enrollment was 10,024, with 462 LPN/LVN students, 1,529 ADN students, 3,560
LPN/LVN/ADN (1PLUS1) students, and 4,473 BSN students. Of the available 10,024 CCAPNS
enrolled, 2,268 qualified for NSUD advancement but cannot enroll. Reasons for qualified
CCPANS not being admitted to NSUD include limits on enrollment, budget constraints,
insufficient clinical supervisors, lack of clinical sites, insufficient faculty, and lack of classroom
space. Standardized testing and reference materials used were 99% ATI, 40% HESI, 14%
Kaplan, 14% Hurst, 16% PreU, 16% Passpoint, and 5% Sanders, with fee-for-service
standardized test preparation costs exceeding $700 and offering little or no score increase
guarantee toward earning an ACT 18 score. Expanding SCHOOLS to all 24 ADN programs
could save each CCAPN a $450 expenditure for standardized test preparation, resulting in a 5-
point ACT composite score increase, allowing qualified CCAPNS to advance to NSUD.
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One strategy for SCHOOLS’ expansion is to offer ACT test preparation to the newly
formed HBCC/PBCC Network funded by the Lumina Foundation and the Annie E. Casey
Foundation in partnership with Complete College America (Complete College America, 2023).
This hub provides a collaboration and knowledge-sharing platform for HBCCs and PBCCs. The
higher education and workforce ecosystem share innovative strategies to improve student
success, bridge equity gaps, and heighten the value and narrative of the 22 colleges in the
network are shared within the higher education and workforce ecosystem. Recently, the ECMC
Foundation developed targeted support for Alabama’s eight HBCCs (Mishra, 2023). SCHOOLS
could partner with Alabama Possible to increase ACT 18 score attainment rates and NSUD
advancement with the eight HBCCs first in 2023 and continuing expansion to all 22
HBCCs/PBCCs by 2025.
On November 10, 2022, the Alabama State Board of Education passed a policy requiring
the graduating class of 2028 to complete one of 10 college and career readiness benchmarks as a
requirement for high school graduation. The following ACT composite scores or subscores earn
U.S. national benchmarks: English (18), math (22), reading (22), science (23), or composite (21).
Without intentional individualized support for students, the Alabama graduation rate will likely
decline, and the high school drop-out rate will increase.
SCHOOLS could be offered to middle and high school students throughout the state
virtually beginning in eighth grade as a dual-enrollment online course within Elm Community
College. Doing so, K–12 students could benefit from meeting two of the 10 new credentialing
benchmark requirements: Benchmarks 1 and 4 (Table 10). Achieving ACT national
benchmarking levels would satisfy Benchmark 1 (Table 10). Consequently, middle and high
school students who take a SCHOOLS ACT test preparation intensive, earn an ACT score of at
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least 18, and complete the course for college credit at Elm Community College would satisfy
Benchmark 4 (Table 10).
Recommendation 2: Revisit SCHOOLS’ Program Components to Increase End-User
Usefulness
Based upon the findings, per survey respondents’ report, the most useful program
components for end-users were the ACT practice test exemplars, the ACT practice tests, the
weekly homework checklists, the welcome and orientation materials prior to the program, and
the Google Classroom. These program components do not require that a live SCHOOLS
Academic Coach be present to teach the ACT test preparation intensive. Removing the live
Zoom class meetings, the live instructional videos, and the Remind App could increase end-user
usefulness, as survey respondents deemed these program components less useful.
Survey respondents deemed the following components as most useful: the practice test
exemplars, the practice tests, the weekly homework checklists, the welcome and orientation
materials prior to the program, and the Google Classroom. Delivery of the key activities for each
of the two modalities (practice tests, exemplars, weekly homework checklists, welcome and
orientation materials, and the Google Classroom) can occur without live instruction. The full
ACT preparation intensive offered online and onsite courses covers 1,250 review questions. Over
5 weeks, the five 4-hour live instructional sessions can be removed and replaced by LMS
instructional content videos. The refresher preparation intensive offers online-only courses
covering 625 review questions. Over 2 weeks, the eight 1-hour live instructional sessions could
be removed and replaced by LMS instructional content videos. The full and refresher modalities
could still include 8 hours of homework provided online and 24/7 access to the SCHOOLS
learning management system.
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The instructional components, the videos, and test preparation information techniques are
essential to ACT 18 score attainment. Survey respondents stated enjoying the impactful videos.
SCHOOLS affords mastery of the ACT test through repeated measures testing of test preparation
information techniques. Survey respondents stated that they did not know how to take the test or
the information on how to master the test prior to participation in SCHOOLS.
Since survey respondents rated the live components of SCHOOLS (Zoom class meetings,
ACT prep instructional videos, and Remind app) less than 9.0/10 in usefulness, a course using a
subscription-based, self-study model including only practice Tests, exemplars, and weekly
homework checklists without live academic coaching or constant reminders might prove more
useful to participants. Once developed, SCHOOLS could beta-test the new modality to determine
if usefulness rates increased or decreased.
To continue to produce +5 ACT composite score increases, SCHOOLS would need to
continue offering test preparation information techniques in both modalities. The practice tests
and exemplars foster higher-order thinking. Survey respondents stated that they did not know
how to answer the questions from each section and had not seen the practice test before
participating in the Zoom teachings. Pre-recorded Zoom teachings can continue engaging
instructional time to increase the knowledge gained through knowing how to actually take the
test and to continue taking multiple practice tests, deemed valuable per survey respondents,
through a self-paced modality, and no longer need to be live per survey respondents’ usefulness
ratings.
One strategy to determine the effectiveness of a new modality is to beta-test a 2-week and
5-week intensive that uses only a self-paced version of SCHOOLS. SCHOOLS could create a
subscription-based model where CCPANS log into the Google Classroom, receive their weekly
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homework checklists and assignments, review their practice tests and exemplars, and complete
their own pre- and post-mock tests using the honor system to score their results. Those using this
new model would not interact with academic coaches, as welcome and orientation materials prior
to the beginning of the program, deemed useful by survey respondents, could be embedded in the
Google Classroom. I could beta-test this new modality during the first semester of nursing school
to not harm CCAPNS who do not earn an ACT 18 score using the new modality and offer
sufficient time for CCAPNS to self-correct and join the traditional program offering with live
academic coaches during their second and third semesters of nursing school.
Delimitations and Limitations
Lunenburg and Irby (2008) stated that delimitations are boundaries that the researcher
self-imposes upon the purpose and scope of the study. The delimitations of this dissertation are
as follows:
● This dissertation was limited to CCAPNS enrolled at Elm Community College who
completed either a 2-week or a 5-week ACT prep intensive from 2018 to 2022.
● The SCHOOLS programs ACT prep intensives were the 2-week refresher intensive
and the 5-week full intensive curriculum taught onsite and online.
● The sample was limited to CCAPNS enrolled in Elm Community College who
completed either a 2-week or 5-week modality of SCHOOLS.
Lunenburg and Irby (2008) stated that limitations may affect the interpretation of findings
or the generalizability of the study’s results, which are not under the researcher’s control. The
limitations of this dissertation are as follows:
● I could not control when CCAPNS took the ACT.
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● CCAPNS voluntarily self-selected, paid for, and chose their modality of preparation.
They only needed to enroll in one of the preparation modalities to be included in the
dissertation.
● I could not control the rate of self-reporting for survey respondents.
Recommendations for Future Research
The recommendations for future research are to further address access, advisement, and
assistance barriers, especially for Black females and K–12 students from under-resourced
communities seeking community college admission. Future research could also investigate the
systemic racial segregation factors that disproportionately hinder ACT 18 score attainment,
increase ADN program attrition, and perpetuate nursing shortage for CCAPNS from under-
resourced communities. These factors place BIPOC, LatinX, and rural students in jeopardy of
not earning an ACT 18 score, leading to community college exit and student-loan debt from lack
of NSUD advancement. Based on this dissertation’s findings regarding SCHOOLS’
effectiveness in providing ACT test preparation, I propose two recommendations for future
research. The first is a study of the impact of the ACT policies on Black women’s career
advancement in nursing. The second is a study of the effectiveness of SCHOOLS ACT test
preparation intensives for middle and high-school students from marginalized communities
seeking high school graduation and community college admission as an expedited route to CCR
benchmark credentialing in Alabama.
First, future research could investigate the effects of not earning an ACT score of at least
18 for Black women. Black women comprised the majority of this dissertation’s subjects. Survey
respondents were 83.3% female and 63.3% Black (Tables 18 and 19). The archival program
records data review participants were 60% female and 65% Black (Tables 20 and 21). Future
88

research could explore the intersectionality of being a Black female CCAPNS at Elm
Community College using the five theoretical frameworks presented in the Belle Obsidian
Principle (Figure 2) to capture their experiences as a counternarrative voice to the systemic racial
segregation they faced prior to earning CCAPNS status at Elm Community College.
This study found that Black women are not persisting in NSUD advancement, ADN
program completion, and RN licensure. Dissertation findings present that Black females gained
CCAPNS status at Elm Community College despite 15.4% residing in Alabama’s lowest-poverty
zip codes. These Black females self-reported As and Bs as their last grades in math (74.2%) and
science (79.6%), subjects regarded with predictive validity for nursing school success and ADN
program completion (Tables 22). Nevertheless, despite more than half (79.31%) indicating that
they had previous medical certification, which required passing a national board examination, at
the time of the survey, most (64.29%) indicated that they were no longer CCAPNS at Elm
Community College. If they used student loans to fund their ADN pursuit, they amassed debt not
offset by the wage-earning increase or net benefit of gaining ADN licensure.
Second, future research could investigate the effects of low ACT scores on K–12 students
from marginalized communities seeking high school graduation and community college
admission. Alabama’s low ACT pass rate among high school graduates and the U.S. Black–
White ACT test score gap have historically persisted since segregation. The ACT is the gold
standard for nursing school success predictive validity. It now equally stands as the gold standard
for high school graduation in Alabama, beginning with the graduating class of 2028, despite the
sociohistoric, socioenvironmental, and socioeconomic objections to the test’s use (“Black
Students’ Scores,” 2021; World Population Review, 2022).

89

Conclusion
This dissertation evaluated the effectiveness of SCHOOLS in increasing rates of ACT 18
score attainment for CCAPNS to increase rates of NSUD advancement. Failure to earn that score
prohibits RN licensure, leading to a nursing shortage while decreasing diversity, equity, and
inclusion rates in the U.S. RN workforce. The focus of the problem of practice for this
dissertation dealt with utilizing high-quality, cost-effective ACT test preparation given by
SCHOOLS to CCAPNS embedded in the ADN nursing program at Elm Community College to
increase ACT 18 score attainment.
The SCHOOLS ACT test preparation program, available to students through select
community colleges or self-pay, onsite or online, offers a promising approach to increasing
success rates on the ACT and NSUD advancement. Dissertation findings reveal that this
implementation-ready promising practice, whether embedded in pre-nursing school community
college courses, offered fee-for-service to all students, or made institutionally available to under-
resourced high school students, effectively raises ACT composite scores by five points. Since
this dissertation’s research efforts began, two of the 24 Alabama community colleges adopted
SCHOOLS in their ADN study plan.
In the United States, K–12 schools and community college ADN programs face pressures
to expedite workforce entry and maintain new graduate rates. These pressures often occasion
policy without careful consideration of the impending issues and implications of the policy’s
enforcement. This was the case with ACT 18 score attainment as a requirement for NSUD
admission and advancement, and such could be the case for Alabama’s CCR credentialing
requirements for high school graduation effective November 2022 (Powell Crain, 2022).
90

The effectiveness of SCHOOLS in raising composite ACT scores to 22 could occasion a
ripple effect for CCAPNS ACT 18 score attainment and high school graduation with
credentialling in light of the new high school credentialing mandate. As a social agent for
change, I aim to conduct further research to critically examine high-quality, cost-effective ACT
test preparation access to dismantle anti-Black racism and discrimination in work settings,
academic institutions, and K–12 educational settings to guide change in the community college
nursing and K–12 education professions. As a Black female and Southern BSN, I take personally
the charge to establish equitable best practices in promoting systems of health, justice, and
economics in the nursing and education professions, especially for amplifying the voices of
Black women lacking access, mentorship, and support in the face of systemic racial
discrimination.

91

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Abstract (if available)

Abstract Addressing American College Testing (ACT) 18 score attainment failure is important to improving ADN program viability as well as community college admitted pre-nursing students’ (CCAPNS) personal and professional growth, self-efficacy, and employability. The purpose of this dissertation was to evaluate the effectiveness of the Success Can Happen Out of Low Scores (SCHOOLS) test preparation intensive programs in increasing attainment rates of scores of 18 or higher on the ACT. Four evaluation questions examined participants’ perceptions of the program’s usefulness and the extent to which it and its components impacted their knowledge about preparation practices and test processes, influenced their test self-efficacy, and increased their score to at least 18. Results revealed a 50% or higher increase in satisfaction rates, test self-efficacy, attainment of a score of 18, and mock composite post-test scores. Two recommendations emerged for program assessment, planning, implementation, and evaluation. Although failure to earn an 18 score on the ACT has been identified as an admission criterion-related barrier to ADN program success, a research gap exists regarding evidence-based admission policies to reduce attrition. The aim of this dissertation was to address the research gap with an implementation-ready promising practice.

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Core Title Success can happen out of low scores! Addressing nursing shortage with SCHOOLS ACT prep: a Kellogg logic model theory of change removing systemic barriers to ACT 18 score attainment for community...

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Publication Date 07/28/2023

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Tag ACT,ACT 18,admission requirements,ADN,ADN students,attrition rates,community college,nursing school,nursing shortage,OAI-PMH Harvest,pass rates,pre-nursing students,program entry,removing systemic barriers,score attainment,success factors,test preparation,upper division,workforce development

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