People are failing! Something needs to be done: Canadian students' experience with the NCLEX-RN

Comprehensive licensure review and adaptive quizzing assignments for enhancement of end-of-programme exit examination scores in Saudi Arabia: a quasi-experimental study

OBJECTIVE

This study explores the effectiveness of a comprehensive licensure review and adaptive quizzing assignments intervention in improving the performance of undergraduate senior nursing students on the end-of-programme exit exam.

DESIGN

A quasi-experimental single-group design was used to compare pretest and post-test scores through computerised adaptive tests.

SETTING

The setting was a nursing college in Saudi Arabia.

PARTICIPANTS

The study included 292 senior nursing students enrolled in the Bachelor of Science in Nursing programme.

INTERVENTION

A comprehensive licensure review bundled with adaptive quizzing assignments was delivered over 15 weeks in the academic year 2021-2022. The bundle was guided by the elaboration theory, and it included 3-hour synchronous lectures every week and 23 adaptive quizzing assignments that covered weekly content.

PRIMARY AND SECONDARY OUTCOME MEASURES

Students' mastery scores and the percentage of correct answers were the primary and secondary measures, respectively. Both measures were collected in the pretest and post-test (exit examination). Additionally, demographic characteristics were collected in the pre-test using an online survey.

RESULTS

The overall mean of the mastery score was statistically significantly higher in the exit exam (M=2.51, SD=1.70) than in the pretest (M=1.45, SD=0.44; p<0.001). Although the overall mean of the mastery score in the exit exam did not reach the cut-off score, students who demonstrated the required knowledge and satisfactory performance in the pretest achieved a mastery score above the cut-off. The percentage of correct answers was statistically significantly higher in the exit exam (M=58.59%, SD=9.50) than in the pretest (M=49.32%, SD=9.78; p<0.001). A statistically significant difference in students' performance based on gender, age and grade point average was observed.

CONCLUSIONS

A comprehensive licensure review and adaptive quizzing assignments intervention bundle fostered the performance of undergraduate nursing students in the end-of-programme exit exam.

Impact of anesthetist licensing examination on quality of education in Ethiopia: a qualitative study of faculty and student perceptions

BACKGROUND

Ethiopia drastically increased the anesthesia workforce density by training 'associate clinician anesthetists' as a task-shifting and sharing strategy. However, there were growing concerns about educational quality and patient safety. Accordingly, the Ministry of Health introduced the anesthetist national licensing examination (NLE) to assure the quality of education. However, empirical evidence is scarce to support or refute the overall impact of NLEs, which are relatively costly for low- and middle-income settings. Therefore, this study aimed to explore the impact of introducing NLE on anesthetists' education in Ethiopia.

METHODS

We conducted a qualitative study using a constructivist grounded theory approach. Data were prospectively collected from ten anesthetist teaching institutions. Fifteen in-depth interviews were conducted with instructors and academic leaders, and six focus groups were held with students and recently tested anesthetists. Additional data were gathered by analyzing relevant documents, including versions of curricula, academic committee minutes, program quality review reports, and faculty appraisal reports. Interviews and group discussions were audiotaped, transcribed verbatim and analyzed using Atlas.ti 9 software.

RESULTS

Both faculty and students demonstrated positive attitudes toward the NLE. Student motivation, faculty performance, and curriculum strengthening were the three primary changes that emerged, resulting in three subsequent spin-offs on assessment, learning, and quality management practices. Academic leaders' dedication to evaluating examination data and turning these into action led to changes that improved education quality. Increased accountability, engagement, and collaboration were the predominant factors facilitating change.

CONCLUSION

Our study indicates that the Ethiopian NLE has prompted anesthesia teaching institutions to improve their teaching, learning, and assessment practices. However, more work is required to improve exam acceptability among stakeholders and drive broader changes.

Supporting Canadian Nursing Students to Write the NCLEX-RN Exam: A Three-Phased Mixed Methods Descriptive Design

BACKGROUND

In 2015, the College of Nurses of Ontario, replaced the Canadian Registered Nurse Examination with the NCLEX-RN exam as entry-to-practice. Faculty in a college-university partnership searched for products to provide nursing students with focused practice in writing exams modelled on the Canadian NCLEX-RN test plan.

PURPOSE

The aim of this three-phased evaluation study was to test and validate NCLEX-RN exam preparation materials newly developed for the Canadian context.

METHODS

A mixed methods descriptive design was used to capture subjective perspectives and objective measures. After ethical approval was obtained, 13 students assessed the e-learning platform's usability. Eight faculty/clinical experts assessed the content validity of materials using a content validity index (CVI) at both item (I-CVI), and scale (S-CVI) levels. Lastly, 72 completed tests served as the basis for assessing psychometric properties of selected test items.

RESULTS

Materials were assessed as useful and easy to use and navigate. I-CVIs ranged between 0.5 to 1.0 with none falling below 0.5 while S-CVIs were above the standard for acceptability of greater than 0.8 with none falling below 0.9. Overall test reliability measured by the Kuder-Richardson formula was 0.73. Many items assessed for difficulty (64%) showed a proportion of correct responses within desired ranges, and most point-biserial indices ranged from fair to very good.

CONCLUSION

Strong evidence supported the usability and content validity of the materials assessed. Item difficulty and discrimination analyses were within acceptable ranges. Suggestions for improvements were offered. Predictive analysis should form the basis of future research in this area.

NCLEX-RN© preparation resources available online in French: An integrative review

AIM

This review describes the availability of online French NCLEX-RN^© preparation resources for candidates BACKGROUND: One entry to practice requirement for Canadian nurses is to successfully pass a licensing exam upon graduation from their educational program. In 2015, the American NCLEX-RN^© replaced the Canadian entry to practice licensing examination which was offered in Canada's two official languages: English and French. The NCLEX-RN^© was developed in English and later translated to French. Since its implementation, Francophone candidates and educators in Canada have reported a lack of preparatory resources available in their language and have had substantial lower NCLEX-RN^© pass rates, consistently below 50% METHODS: An integrative review using Whittemore and Knafl's framework was conducted between February and May 2019, and updated in September 2020, through online searches of CINAHL, PubMed, Science Direct and Google Scholar databases. Grey literature was included from 2012 onwards. Results are presented narratively.

RESULTS

A total of 17 French language preparatory resources were found. These resources were categorised into four main groups: (1) What is the NCLEX-RN^© ?; (2) What do I need to do prior to writing the NCLEX-RN^© ?; (3) What is assessed through the NCLEX-RN^© ? and finally, (4) How can I practice before taking the NCLEX-RN^© ?

CONCLUSION

Limited French-language NCLEX-RN^© preparatory resources exist for Francophone candidates. Furthermore, practice questions in French are few compared to what is available in English IMPLICATIONS FOR NURSING AND NURSING POLICY: Other countries may consider implementing an entry to practice exam such as the NCLEX-RN^© because of its availability in both the French and English language, as well as the possibility of translating the exam to other languages, creating a potential market for this test around the globe. The lack of preparatory resources in French is a major concern to Francophone candidates undertaking such a high-stakes examination in their language. Nursing stakeholders and policy leaders should acknowledge that such gaps place Francophone writers in a disadvantaged position in comparison to their Anglophone counterparts.

A 15-Year Trend Study of Internationally Educated Nurses' NCLEX-RN Performance

AIM

The aim of the study was to describe trends in internationally educated nurses' (IEN) National Council Licensure Examination-Registered Nurses (NCLEX®-RN) performance from 2003 to 2017 and to determine the odds of passing the exam based on country of nursing education.

BACKGROUND

IEN comprise 5.6 percent of US nurses; more than half come from the Philippines. There is a lack of research on IEN NCLEX-RN performance.

METHOD

Correlational research was used to determine the performance and likelihood of passing the NCLEX-RN based on country of nursing education using secondary data analysis. Odds ratios were estimated to express the odds of passing.

RESULTS

IEN NCLEX-RN applications and pass rates are decreasing. The odds of passing the NCLEX-RN among Philippine-educated nurses are lower compared to all other IEN. The odds of passing the Canadian NCLEX-RN are higher for all IEN.

CONCLUSION

The low NCLEX-RN pass rate of IEN reflects differences in nursing education and practice across countries.

Adoption of NCLEX-RN for licensure in Canada: Faculty concerns and implications for nursing education

This paper highlights questions about Canadian nurse regulators' adoption of the U.S.-based NCLEX-RN examination, effective 2015, as the only route to initial registered nurse licensure in all jurisdictions, excluding Quebec. The decision for this change was made by the Canadian Council of Registered Nurses Regulators (CCRNR), an umbrella association of CEO's of provincial regulatory bodies in collaboration with the National Council of State Boards of Nursing (NCSBN). Adoption and implementation of this new policy was accomplished by the Council of each provincial regulatory body. This change, representing the first international adoption of NCLEX-RN, was deemed successful by CCRNR and NCSBN. However, the Canadian Association of Schools of Nursing (CASN) described the decision as unilateral and unwise, questioning the applicability of NCLEX-RN in the Canadian context, citing significant French language translation issues and unacceptable pass rates. Both authors have had extensive academic nursing experience in U.S. and Canada. Both had many conversations with Canadian colleagues who described the impact on nursing education as disastrous. Most of our American colleagues knew nothing about this change, but once informed, expressed some concerns similar to those of their Canadian counterparts. We suggest that international adoption of a US-based examination for initial licensure merits wider discussion by nursing faculty here and abroad.

Undergraduate nursing students' experiences of anxiety-producing situations in clinical practicums: A descriptive survey study

BACKGROUND

Clinical practicums are regarded as one of the most anxiety-producing aspects of the curriculum by nursing students. Practicum-associated anxiety has negative impacts on learning, performance, and well-being. Little is known about what makes final year nursing students anxious during their practicum experience and the impact of clinical and student characteristics on their level of anxiety.

OBJECTIVES

The objectives of the study were (1) to explore which clinical situations final year nursing students perceive as anxiety-producing; (2) to identify if perceived level of anxiety associated with clinical tasks differ by clinical and student characteristics; and (3) to determine the relationship between clinical and student characteristics and perceived level of anxiety among nursing students.

DESIGN

Descriptive, cross-sectional survey.

SETTING

One university in Ontario, Canada.

PARTICIPANTS

A convenience sample of 93 final year undergraduate nursing students.

METHODS

The Clinical Experience Anxiety Form (CEAF) was administered to assess perceived level of anxiety associated with common practicum tasks. Descriptive statistics, one-way analysis of variance, and Pearson's correlation tests were used to address the research questions. Content analysis was conducted for open-ended questions.

RESULTS

Participants reported the following three situations as most anxiety-producing: fear of making mistakes, being observed by instructors, and initial clinical experience on a unit. Differences were noted between younger (18 to 24 years-old) and older (25 to 34 years-old) students, with the older student group reporting lower levels of anxiety associated with the following clinical situations: being observed by instructors and asking questions of faculty. Age was also found to be negatively correlated with CEAF scores wherein younger students reported higher CEAF scores. Content analysis indicated common areas that worried participants most about their practicum and their academic year.

CONCLUSIONS

Findings emphasize the importance of nursing educators to recognize anxiety-producing practicum situations and develop anxiety management interventions to ensure optimal learning.

The Work of Preparing Canadian Nurses for A Licensure Exam Originating from the USA: A Nurse Educator’s Journey into the Institutional Organization of the NCLEX-RN

The licensing exam for registered nurses in Canada has recently been changed from a Canadian developed, owned and delivered exam to the National Council Licensure Examination for Registered Nurses (NCLEX-RN) which originates from the United States. Rationale for this exam change focused on transitioning to a computer-based exam that has increased writing dates, with increased security, validated psychometrics, increased exam result delivery, and an anticipated decrease in expense to students. Concerns have arisen around the acceptance, implementation and delivery of this exam to Canadian nursing students that reflects the broad Canadian landscape of education and nursing practice. The experience of a Canadian nurse educator in working to facilitate students’ transition to this exam is addressed using an institutional ethnographic lens. Finally, we come to conclusions about the importance of countries utilizing licensing exams that reflect their nursing education and practice

Registered Nurses' Experiences of Passing the NCLEX-RN After More Than One Attempt

BACKGROUND

In the past decade, little research has been conducted regarding individuals' stories about not initially being successful on the National Council Licensure Examination for Registered Nurses. An unsuccessful licensure examination attempt may affect the individual personally and profoundly in ways that could influence their future success.

METHOD

Individual in-depth interviews were conducted once with 15 RNs who were initially unsuccessful on the licensure examination and subsequently passed. Data analyses were conducted using both manual and electronic coding through thematic identification. Rigor was ensured by meeting quality criteria for qualitative research.

RESULTS

Four themes were identified: (a) Pressures all Around, (b) the Stigma of Being Unsuccessful, (c) Correcting the Problems, and (d) Ultimate Triumph in Discovery.

CONCLUSION

Following their initial unsuccessful National Council Licen-sure Examination for Registered Nurses results, participants were deeply affected, but after accepting help from family, friends, nursing instructors, and managers, they were able to move forward, change their approaches, and become RNs. [J Nurs Educ. 2018;57(10):590-597.].