Best Practices Issue - May 2023

In 2020, the NCLEX pass rates for first-time test-takers dropped to 64%, which resulted in the [Chipola College associate nursing] program needing to submit a follow-up report to continue accreditation for Good Cause. Faculty began researching how to improve student success on passing the NCLEX on the first attempt. Faculty contacted similar colleges with 2-year RN programs with first-time pass rates greater than 90%. Evidence-based nursing education articles were reviewed to assist with a plan to improve student success. The combination of success strategies used by similar 2-year RN programs, a literature review, and a retrospective review of our students who passed the NCLEX on the first attempt compared to those who did not. It is essential to review admission requirements, progression policies, and end-of-program outcomes not only for a continuous improvement plan (CIP), but also for the systematic plan for evaluation (SPE) (Serembus, 2016).

Faculty discovered when reviewing other nursing programs and available research that there were similarities. There were correlations between science and reading scores, prerequisite GPA,  and NCLEX predictor exams each semester with nursing school success and passing NCLEX on the first attempt (Rigsby-Robinson & Glisson, 2019; Van Hofwegen, et al., 2019; Wolkowitz & Kelly, 2010). Internal (study skills, learning style, etc.) and external (work, family obligations, etc.) influence students’ success in nursing school and subsequently passing NCLEX on the first attempt (Wilson-Anderson, 2020). Morrison, et al. (2005) discovered that a remediation progression policy would improve NCLEX pass rates. The five different nursing programs who participated in that study used different remediation policies; however, had similar results with improved NCLEX success.

Admission criteria were reviewed to determine correlation between prerequisite GPA, overall points on the admission application, and success in the nursing program through passing NCLEX on the first attempt. It is common for nursing programs to evaluate admission criteria, progression policies, the use of standardized exams before making changes to improve NCLEX pass rates (Loftin, et al., 2020). Additionally, implementing strategies for success such as assisting students with developing a personal learning plan; helping students examine their learning styles, grades in the courses, and scores on standardized exams; and understand how external situations influence their success improves NCLEX success (Wilson-Anderson, 2020).

Therefore, faculty realized they must take an approach that involved multiple interventions to increase first-time pass rate on the NCLEX-RN. The CIP involved changes to admission criteria; development of a remediation policy based on comprehensive exams and the NCLEX predictor exam; increasing active learning strategies in the classroom; providing more simulation scenarios aligned with lecture content to improve student learning and clinical judgment; and a faculty mentor program. Previously, the prerequisite GPA was 2.50, which was calculated on these courses: English I, College Algebra, General Psychology, Anatomy and Physiology I, and a Civics course. Students with a GPA closer to a 3.0 or higher were more likely to complete the program on time and pass the NCLEX-RN on the first attempt. After a discussion with faculty and administration, a decision was made to increase the prerequisite GPA to 2.75 starting with the fall 2022 admitting class.

Changes made to improve the progression, graduation, and NCLEX success included implementation of a faculty mentoring program and individualized remediation plans for unsuccessful students. To increase student/faculty engagement, the ADN program faculty implemented an appreciative advising program, which pairs a nursing faculty mentor with each ADN student from admission to post-graduation. The purpose of this program was to facilitate relationship building for personal and professional growth by offering support services to all students. The mentor develops a relationship with each student that extends post-graduation. This strategy was implemented to increase program completion, first-time NCLEX pass rates, and job placement responses. Because faculty developed a relationship with these students, they contact them 6-months and 12-months post-graduation to obtain job placement data.

When students withdrew or failed a course, they were required to complete remediation as part of the reentry process. Each faculty mentor would assign, review, and approve the completed remediation for the student mentee. Once the faculty mentor approved the completed remediation, the student could retake that course.

Since starting the mentor program, there has been increased job placement data as a result of faculty maintaining contact post-graduation. Focus groups conducted with graduating students revealed an overall positive response to the faculty mentoring. A survey sent out to current students and graduates from the past year revealed that 73% were satisfied or very satisfied with the overall mentorship program and 81% reported having a mentor was helpful to their overall success.

If you are a nursing program struggling with retention, graduation, and/or NCLEX pass rates, it is essential to review all potential contributing factors. The SPE guides your program through evaluating the end-of-program-student-learning-outcomes. In addition, a comprehensive CIP gives an opportunity to collect and analyze data that is not a part of the SPE.

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