Predictors of First-Time NCLEX-RN Pass Rate in Accelerated Bachelor of Science in Nursing Students

BACKGROUND

An accelerated Bachelor of Science in Nursing (ABSN) program was introduced in an effort to reduce the nursing shortage in response to the growing health demands. Nursing educators strive to examine factors that promote students' success in passing the National Council Licensure Examination for Registered Nurses (NCLEX-RN) on their first attempt. However, little is known about which factors predict the NCLEX-RN first-time pass rate of ABSN students.

METHOD

This descriptive retrospective study examined academic and nonacademic indicators (e.g., age) that can predict ABSN students' NCLEX-RN first-time pass rates between 2008 and 2019.

RESULTS

A total of 591 ABSN students were included in the study. Both GRE (Graduate Record Examination) verbal reasoning scores (p < .001) and cumulative grade point averages (p < .001) were significant predictors.

CONCLUSION

The findings of this study can help inform ABSN programs in terms of admission criteria and curriculum consideration for including standardized tests to improve ABSN students' NCLEX-RN first-time pass rate. [J Nurs Educ. 2024;63(1):10-16.].

Nursing Faculty Workforce Development Project

A proposed nursing faculty workforce development project by a college of nursing within a research-intensive institution will increase the number of nurse faculty from the current population of BSN-prepared nurses from underserved communities in a state to earn a master of science in nursing (MSN) degree with a nursing education specialty. This project will be accomplished through partnerships between a college of nursing and academic institutions with large nursing student populations from underserved communities. In addition, the project will incorporate the employment of MSN students at academic partner institutions within a clinical nurse faculty role. The proposed project will continue after an initial federally funded grant to continue the project and address the nurse faculty shortage from diverse populations and advance health equity and culturally congruent health care in the state. The project will also enhance partnership building with stakeholders, such as statewide academic institutions, to impact underserved communities.

The Effects of Holistic Admissions on Diversity in Nursing: A Literature Review

BACKGROUND

The nursing profession does not reflect the diversity of the population they serve. Many health professions, including nursing, have altered their admissions practices to consider a holistic assessment of individuals. Quantitative data from students are not sufficient to develop a diverse student body.

METHOD

A literature review was conducted using MEDLINE, CINAHL, ERC, ERIC, and Google Scholar. Original research articles on holistic admission (HA) processes and the effects on diversity in nursing were included in the review. Search terms were "holistic admission," "holistic review," and "nursing."

RESULTS

There is a paucity of research regarding HA in nursing. The available literature suggests HA increases the odds of developing a more diverse student population.

CONCLUSION

HA should be considered to increase diversity of students. Further research is needed regarding the effects of HA on diversity among nursing students. [J Nurs Educ. 2023;62(10):556-562.].

Developing a mission statement to reflect the diversity, equity, and inclusion values and priorities of a College of Nursing

A mission statement represents an organization's values, expectations, and priorities and guides its strategic decision-making. This article describes an innovative and iterative process for developing mission statements to reflect and guide the diversity, equity, and inclusion values of schools and colleges of nursing. The process began with extensive input from the faculty during the fall 2021 faculty retreat using a World Café approach. Following the retreat, members of the Equity and Inclusion Committee reviewed the information from the faculty about the college's values, goals, and vision for our tripartite mission. In drafting the mission statement, the Equity, and Inclusion Committee, which includes faculty, staff, and student representation from the college's multiple regional campuses, units, and departments, met to craft an initial draft collaboratively. The initial draft of the mission statement was then circulated to the Faculty Leadership Team, the Faculty Executive Committee, and individual departments within the college for feedback. Committee members used the input and suggested revisions to refine and finalize a proposed new mission statement. A survey was distributed to faculty, staff, and students to provide quantitative and qualitative feedback about the proposed mission statement (N = 125). Mean scores suggested agreement that the new mission statement reflected the values and future direction of the college (M = 7.91), aligned with personal values and career goals (M = 8.25), and its achievement would advance the discipline of nursing (M = 8.30). The level of support for adopting the new mission statement was strong (M = 7.83). Most of the faculty voted to adopt the new mission statement at a faculty meeting (N = 98, 85 %). The strategies described have implications for guiding the development of mission statements to speak to the issues of diversity, equity, and inclusion as core values and priorities of schools and colleges of nursing.

Topic: Intentional diversity in academia: Recruiting, admitting, enrolling, and retaining underrepresented students in nursing programs

Currently, 60 % of the United States population is White, while the remaining belong to ethnic or racial minorities. By 2045, the Census Bureau predicts that there will no longer be any single racial or ethnic majority group in the United States. Yet, people across all healthcare professions are overwhelmingly non-Hispanic and White, leaving people from underrepresented groups severely underrepresented. The lack of diversity in healthcare professions is an issue because there is overwhelming evidence that patients from underrepresented groups experience disparities in healthcare at alarmingly high rates when compared to their White counterparts. Diversity is especially important in the nursing workforce since nurses are often the healthcare providers that engage with patients the most frequently and intimately. Additionally, patients demand a diverse nursing workforce that can provide culturally competent care. The purpose of this article is to summarize nationwide undergraduate nursing enrollment trends and discuss strategies to improve recruitment, admissions, enrollment, and retention of nursing students who belong to underrepresented groups.

Admission characteristics that influence DNP students' first-semester success: A retrospective study

BACKGROUND

Students apply to Doctor of Nursing Practice (DNP) programs with varying demographic, academic, and professional characteristics. Programs are challenged with selecting and retaining students. Suggestions regarding which admission criteria and student characteristics are influential for success have been inconsistent. Recently, holistic admission practices have been employed to increase diversity, but little is known on the relationship between holistic admissions and student success.

OBJECTIVE

To investigate which demographic, academic, and professional characteristics influence DNP students' first-semester success.

DESIGN

Retrospective study using online DNP student application materials at a medium-sized, mid-Atlantic private university.

METHOD

Investigators used a self-developed Audit Tool to identify characteristics of enrolled DNP students' application materials (n = 245). Categorical and continuous data were analyzed using χ² and Independent Samples t-tests to determine which characteristics influenced success.

RESULTS

Analysis revealed none of the items related to student characteristics were associated with first-semester academic success.

CONCLUSION

Further research is needed. Studies exploring additional individual characteristics and time frames may be more predictive of first-semester academic success.

Holistic Admissions Review Integration in Nursing Programs

BACKGROUND

To address health inequities, the American Association of Colleges of Nursing, Institute of Medicine, and Association of American Medical Colleges recommend holistic admissions review (HAR) to increase health professional diversity.

METHOD

This cross-sectional study collected admissions criteria from 1,547 nursing programs. Criteria were categorized according to the experiences, attributes, and academic metrics (EAM) model, and programs were dichotomized into those with holistic admissions criteria versus none.

RESULTS

Only 43% of nursing programs considered holistic admissions criteria. Regionally, rates varied from 35% in the South to 54% in the West. The rate of HAR integration exceeded 67% in only six states.

CONCLUSION

Nursing programs have not widely integrated HAR despite evidence that academic metric use alone disadvantages qualified underrepresented students. HAR implementation can be facilitated by standardizing how HAR is operationalized and applying best evidence to rubric development that appropriately weighs admissions criteria based on the EAM model, and also training reviewers for unbiased candidate evaluation. [J Nurs Educ. 2022;61(7):361-366.].

Preliminary Evaluation of Applicants to Master's Programs in Speech-Language Pathology Using Vignettes and Criteria From a Holistic Review Process

PURPOSE

Little is known about how others evaluate applicants to master's programs in speech-language pathology along criteria used during holistic review despite more programs adopting holistic review. This knowledge gap limits our understanding of whether holistic admissions may offer a more equitable pathway to entering speech-language pathology. This study investigated how faculty and PhD students evaluated applicants to master's speech-language pathology programs along criteria used during holistic review.

METHOD

We administered a survey online through a Qualtrics platform. Respondents (N = 66) were faculty and PhD candidates in U.S. speech-language-hearing departments. Survey blocks included demographics, professional background, and vignettes. Vignettes featured profiles of applicants to master's programs in speech-language pathology. Vignettes systematically varied in the indicators of applicant criteria, which were specified at low, moderate, or high levels or not specified. After reading each vignette, respondents rated the applicant and indicated their admissions decision. Analysis included descriptives.

RESULTS

Relative to an applicant who was at a high level for all indicators except cultural and linguistic diversity, respondents ranked applicants who varied in their indicators of criteria levels lower. Respondents were also less likely to make an explicit "accept" decision (vs. "waitlist" or "reject") for this latter group of applicants.

CONCLUSIONS

Even when implementing criteria used during holistic review, applicants who vary from a "high-achieving" stereotype may still face barriers to entry. Future work is needed to understand the precise nature of how holistic admissions review may play out in actual practice and help increase diversity in the profession.

Holistic Admissions Review in Nursing Education: A Concept Analysis Using Rodgers' Evolutionary Method

AIM

The aim of this study was to analyze holistic review within the context of collegiate nursing program admissions.

BACKGROUND

Holistic review is the evaluation of individual qualifications for college admission based on a pattern of individualized factors, including standardized scores, personal characteristics, experiences, abilities, and educational/professional "fit." Medical schools regularly use holistic review, and more nursing schools may adopt holistic review in the future.

METHOD

Rodgers' evolutionary method of concept analysis was used to examine usage in current praxis.

RESULTS

Findings support a desire to enhance diversity in collegiate, health-related programs while increasing numbers of culturally competent, qualified providers representative of the US population.

CONCLUSION

Holistic review promotes diversity of nursing students and future nurse providers. This concept analysis provides a unified definition of holistic review to promote educational and health-care-related equity through increased representativeness of nursing students and future nurses.

Cultivating diversity in the advanced practice registered nurse workforce: An exemplar from an advanced practice registered nurse fellowship program

ABSTRACT

Diversity in the nursing workforce is an important driver of patient satisfaction, adherence to care, and quality outcomes. Systemic barriers exist that prevent individuals from underrepresented minority groups entering and advancing in the nursing workforce. To advance the health of the community we serve and with grant support from the Health Resources and Services Administration, we developed a postgraduate advanced practice registered nurse (APRN) fellowship in community health. This program is a partnership between a federally qualified health center and a college of nursing. We developed a deliberate plan to recruit and admit diverse applicants who would continue to practice in our community at the conclusion of their fellowship year. Using targeted recruitment outreach, we identified new-graduate APRNs who were representative of the community we serve. Using holistic review methodology, we interviewed applicants with explicit efforts to mitigate the effects of bias towards race, ethnicity, gender, and academic affiliation. We embraced a quality-improvement ethos that enabled evolution and growth with each iteration of the program. Understanding that intention does not translate to outcomes, we undertook ongoing critique of our methods and engaged diverse resources to improve our processes. Over two admission cycles, our fellowship in community health for new graduate APRNs has demonstrated improvements in strategies to diversify the community health workforce. We will describe our process of nonjudgmental self-critique and a quality-improvement framework that can serve as a strategy to promote diversity, equity, and inclusion in the community health workforce.

Description of a student success program to increase support, coping, and self-efficacy among under-represented minority nursing students in the wake of the dual pandemics of COVID-19 and racial violence

BACKGROUND

Increasing the size and diversity of the nursing workforce is an important priority. Here, we describe a student success program to increase students' perceived support, coping, and self-efficacy for completing the nursing program among underrepresented racial/ethnic minority students in nursing education following the dual pandemics of COVID-19 and racial injustice.

METHODS

In collaboration with the Urban Health Program at the University of Illinois Chicago, we conducted a 15-week online student success pilot program with a volunteer sample of upper-level undergraduate nursing students. The curriculum for the program included topics centered on traditional student success topics and psychological, emotional, and contextual issues associated with student success. The sessions were conducted weekly throughout the Spring and Fall semesters of 2021, lasting 90-min. Quality improvement evaluations included weekly process variables and a post-test assessment.

RESULTS

Participants (N = 35) were primarily female and Hispanic. The program was acceptable, with participants very satisfied with the weekly sessions (83 %). Post-evaluations revealed self-reported improvements in peer support (69 %), confidence in reaching educational goals (94 %), handling microaggressions (77 %), coping with adversity (80 %), stress levels (63 %), and thoughts about leaving the program (86 %).

CONCLUSIONS

This student success program shows promise for improving general and minority-specific factors associated with student success. Additional development and evaluation are needed to determine the program's benefits for a larger group of nursing students.

Strategies to address structural and institutional barriers to success among students of color in nursing programs

The COVID-19 pandemic and the significant disparities experienced by Black, Indigenous, and people of color (BIPOC) in infections, hospitalizations, and deaths associated with the Coronavirus have underscored the imperative to increase the size and diversity of the healthcare workforce, including nursing. Academically focused pipeline development programs have led to some advances in minority recruitment and retention; however, emerging research highlights the importance of extra-academic factors that reduce the sense of belonging and persistence among underrepresented and minority students. The purpose of this manuscript is to describe the diversity, equity, and inclusion goals and activities of a college of nursing located in a minority-serving institution. Here, we emphasize the description of a range of activities aimed at meeting our diversity goals. Further, we highlight the actions initiated in response to emergent "extra-academic" student needs over the past year related to the COVID-19 pandemic and police brutality. The strategies described have implications for improving diversity, equity, and inclusion among higher education institutions in nursing.

How organizational culture influences holistic review: a qualitative multiple case study

Studies primarily involving single health professions programs suggest that holistic review in admissions can increase underrepresented minority (URM) representation among admitted students. However, data showing little improvement in the overall proportion of URMs in many health professions, despite widespread use of holistic review, suggest that relatively few programs using holistic review admit substantial proportions of underrepresented minorities. Therefore, more research is needed to understand factors that facilitate holistic review practices that successfully promote diverse student enrollment. The literature suggests that a supportive organizational culture is necessary for holistic review to be effective; yet, the influence of culture on admissions has not been directly studied. This study employs a qualitative, multiple case study approach to explore the influence of a culture that values diversity and inclusion ('diversity culture') on holistic review practices in two physician assistant educational programs that met criteria consistent with a proposed conceptual framework linking diversity culture to holistic admissions associated with high URM student enrollment (relative to other similar programs). Data from multiple sources were collected at each program during the 2018-2019 admissions cycle, and a coding manual derived from the conceptual framework facilitated directed content analysis and comparison of program similarities and differences. Consistent with the conceptual framework, diversity culture appeared to be a strong driver of holistic admissions practices that support enrolling diverse classes of students. Additional insights emerged that may serve as propositions for further testing and include the finding that URM faculty 'champions for diversity' appeared to strongly influence the admissions process.

Nursing Program Admission Barriers in the United States: Considerations for Increasing Black Student Enrollment

BACKGROUND

The percentage of Black registered nurses (RN) is disproportionate to Black residents in the population, particularly in Southern states.

PURPOSE

This study's purpose was to identify the potential admission barriers for Black students in RN education in the South versus Midwest, Northeast, and West.

METHODS

A cross-sectional design was used to compare admission criteria for 1597 accredited associate degree in nursing and bachelor of science in nursing programs by geographic region.

RESULTS

Southern programs required a significantly higher count of academic metric criteria (multiple grade point average, standardized tests) and nonacademic criteria (proof of health insurance, background checks). Southern programs had a significantly lower count of holistic admissions review criteria (references, essays, volunteer work).

CONCLUSION

Approximately 50% of programs used academic metrics exclusively, and most programs using some holistic criteria assigned greatest weight to academic metrics despite evidence that this disadvantages qualified, underrepresented students. Access to RN education must be improved. Recommendations are discussed for transition to holistic admissions review.

Educating Nursing Students About Delivering Culturally Sensitive Care to Lesbian, Gay, Bisexual, Transgender, Questioning/Queer, Intersex, Plus Patients: The Impact of an Advocacy Program on Knowledge and Attitudes

AIM

This study evaluated the effects of a program designed to help students provide culturally competent care for lesbian, gay, bisexual, transgender, questioning/queer, intersex, plus (LGBTQI+) patients.

BACKGROUND

The LGBTQI+ community faces disparities linked to stigma and discrimination. The Advocacy™ Program was developed to supplement the curriculum in schools of nursing.

METHOD

Nursing students from six schools of nursing (n = 1,398) received advocacy training. Students were administered the Genderism and Transphobia Scale, the Homonegativity Scale, and additional knowledge questions before and after training.

RESULTS

The findings were positive, indicating an increase in student attitude scores, vocabulary and disparity knowledge, and knowledge regarding care for an LGBTQI+ client (p < .05).

CONCLUSION

By building a culture of inclusion through recognition of diverse patients in the curriculum, nursing schools can develop a culture of connection that strengthens patient-provider relationships and improves mental and physical health.

Outcomes of a holistic admissions process in an Accelerated Baccalaureate Nursing Program

An accelerated bachelor of science in nursing program adopted holistic admissions practices to increase diversity in the student body. This quality improvement project aimed to compare three cohorts of students accepted before holistic admissions practices to three cohorts accepted after holistic admissions. The authors examined demographic data, on-time graduation rate, licensure exam passing rate, remediation status, and student perceptions expressed on exit surveys. After holistic admissions were implemented, student diversity increased and on-time graduation and licensure exam pass rates were maintained. The need for student remediation decreased after holistic admissions were implemented, and student perceptions of their classmates and the relevance of their schooling to their future professional career increased.

Increasing Racial and Ethnic Diversity in Occupational Therapy Education: The Role of Accreditation Council for Occupational Therapy Education (ACOTE®) Standards

Now more than ever, the lack of racial and ethnic diversity must be addressed within the health care system, specifically in occupational therapy. This change starts with the successful completion of educational programs by underrepresented minority (URM) occupational therapy students. To increase diversity in the profession, accrediting bodies should mandate support for students of all backgrounds to be successful in higher education. As addressed in the American Occupational Therapy Association 2020 Code of Ethics, the Vision 2025 statement and its pillars, current knowledge on health disparities and occupational therapy demographic data, and other health professional programs' accreditation standards, there is a need for an addition to, or revision of, the Accreditation Council for Occupational Therapy Education (ACOTE®) standards to support the recruitment and retention of URM occupational therapy students. What This Article Adds: This column provides an evidence-based rationale to address the need for an ACOTE standard requiring documented efforts to support racial and ethnic diversity within occupational therapy education.

Holistic Admissions and Underrepresented Minorities in Physician Assistant Programs

PURPOSE

The purpose of this study was to assess holistic review use in physician assistant (PA) programs and determine whether a relationship between holistic review and underrepresented minority (URM) matriculation exists.

METHODS

Using data from the 2016-2017 Physician Assistant Education Association annual survey of PA programs, we examined the frequency of holistic review use across PA programs. Bivariate correlation analyses and binary logistic regression were used to examine relationships between holistic review practices and program percentages of first-year underrepresented racial and ethnic minority students.

RESULTS

Most PA programs (169/219 [77.2%]) reported using holistic review, and its use modestly correlated with percentage of students who were underrepresented racial minorities (rho = 0.16, 95% confidence interval [CI] = 0.02-0.30) or Hispanic (rho = 0.20, 95% CI = 0.06-0.33). Using several holistic review elements related to program commitment to diversity modestly correlated with percentage of students who were underrepresented racial minorities (rho = 0.25, 95% CI = 0.10-0.39) or African American (rho = 0.20, 95% CI = 0.04-0.34). Additionally, the odds of a first-year student being an underrepresented racial or ethnic minority were slightly higher in PA programs using holistic review (OR = 1.56, 95% CI = 1.23-1.99 and OR 1.33, 95% CI = 1.09-1.62, respectively).

CONCLUSIONS

PA program use of holistic review practices was modestly associated with percentage of URM students. Further research is needed to identify elements that are most effective.

The use of strategies from the social sciences to inform pipeline development programs for under-represented minority faculty and students in the health sciences

Representation of under-represented minority (URM) faculty in the health sciences disciplines is persistently low relative to both national and student population demographics. Although some progress has been made through nationally funded pipeline development programs, demographic disparities in the various health sciences disciplines remain. As such the development of innovative interventions to help URM faculty and students overcome barriers to advancement remains a national priority. To date, the majority of pipeline development programs have focused on academic readiness, mentorship, and professional development. However, insights from the social sciences literature related to "extra-academic" (e.g., racism) barriers to URM persistence in higher education suggest the limitations of efforts exclusively focused on cognitively mediated endpoints. The purpose of this article is to synthesize findings from the social sciences literature that can inform the enhancement of URM pipeline development programs. Specifically, we highlight research related to the social, emotional, and contextual correlates of URM success in higher education including reducing social isolation, increasing engagement with research, bolstering persistence, enhancing mentoring models, and creating institutional change. Supporting URM's success in the health sciences has implications for the development of a workforce with the capacity to understand and intervene on the drivers of health inequalities.

Social justice as an expression of caring through holistic admissions in a nursing program: A proposed conceptual model

AIM

This paper presents HAR as an expression of caring to create social justice within nursing and achieve a workforce that is representative of those being served.

BACKGROUND

The lack of diversity within the health professions has been expressly linked in the literature to health disparities among underrepresented and marginalized groups.

RECOMMENDATIONS

Recognizing the value of diversity within healthcare has been the impetus for some health profession programs to use holistic admissions review (HAR) in the assessment and evaluation of applicant suitability. While current HAR recommendations in nursing broaden the lens on which criteria should be used to determine applicant suitability beyond standard academic metrics, existing models do not examine applicants' caring capacity.

CONCLUSION

Given caring is the essence of nursing, the authors offer a guiding framework to supplement the American Association of Colleges of Nursing criteria for HAR and a model by which nursing applicants are evaluated on their capacity to care.

Nursing's leaky pipeline: Barriers to a diverse nursing workforce

BACKGROUND

Nursing educational programs have been charged with increasing the diversity of the nursing workforce; however, this depends on having a diverse and qualified applicant pool to select from.

PURPOSE

To determine the effects of student losses over time on nursing program diversity.

DESIGN AND METHODS

Descriptive longitudinal study. Progression of all students from a single university enrolled as pre-nursing majors from 2012 to 2016 (N = 2498) was tracked over seven key checkpoints during a seven-year time period.

RESULTS

Slightly more than half of the students (57%) were lost prior to nursing program application, which occurred at the end of the sophomore year. Losses were higher for minority students (70%), those requiring remedial coursework (65%), and first-generation students (62%). Older students, those with a prior degree, and those who started in another major were more likely to persist through some, but not all, of the checkpoints.

CONCLUSIONS

Pre-nursing program losses significantly decreased the diversity of the remaining nursing applicant pool, particularly for African American students. Losses were highest during the freshman level Anatomy and Physiology course. Nursing education programs need to develop early intervention programs to support diverse students during the critical pre-nursing period to increase the diversity of the nursing workforce.