Factors potentially contributing to pass rate decline

Academic preparation of students entering nursing education program

  • Students not prepared academically for rigors of nursing program
  • Student performance in sciences and clinical nursing courses
  • Low reading comprehension skills in spite of passing college level English courses
  • Multiple repetitions/withdrawals allowed for prerequisite sciences and nursing courses
  • GPA required for admission to nursing (related to science performance)
  • Adequacy of high school preparation in basic math, sciences and English
  • Deficiencies in developmental skills, such as reading and math, necessitating intensive academic support which student may not take advantage of because of their employment or child care responsibilities
  • Cut-off scores on standardized admission assessments used for selection of students

Academic "rigor" of nursing education program

  • Extra credit offered for projects
  • Rounding up on grades
  • Few objective tests
  • Test questions constructed at lower cognitive level (many questions at knowledge and comprehension level rather than analysis and application)
  • Students not expected to read materials
  • Overly detailed study guides to teacher made exams encouraged students to study only for exam
  • Grade inflation within nursing and in prerequisite sciences
  • Absence of cumulative exams at end-of-course
  • Multiple repetitions/withdrawals allowed for prerequisite sciences and nursing courses

Nursing student issues

  • Employment 20 hours or more/week
  • Family responsibilities in addition to nursing studies
  • Primary language not English
  • Delay of more than 3 (CA) - 5 (AZ) months in writing NCLEX after graduation (not quantified by MA but several programs report delay linked to success)
  • Values of generation "X"

Nursing curriculum

  • Curricular changes made without NCLEX content mapping (content inadvertently dropped)

Faculty knowledge of current NCLEX test plan

  • Unaware of NCLEX validity and practice-relatedness
  • Unaware of NCLEX content

Nursing Education Program and Faculty Specific Interventions

Nursing program

  • Raise cut score on admission testing
  • Raise pass grade required for progression
  • Eliminate grade inflation, rounding up, "fluff" projects for extra credit, points for attendance
  • Review academic requirements of prerequisite science courses to eliminate grade inflation, rounding up, "fluff" projects for extra credit, points for attendance
  • Incorporate assessment of English proficiency if English is second language, reading level and reading comprehension as part of pre-nursing assessment or counseling newly admitted students to nursing major
  • Require prerequisite course for admission to nursing major be completed within five years prior to admission to nursing major
  • Limit number of times prerequisite science and clinical nurse courses can be retaken
  • Use standardized tests throughout program (some recommend this should be part of course grade)
  • Add comprehensive content/synthesis course during last semester to review content, apply critical thinking skills
  • Develop early intervention programs for "at-risk" students (NCLEX success program begins first day of program)
  • Offer financial help in form of scholarships; partnering with health care employers to offer externships, tutoring and mentoring
  • Support to unsuccessful candidates (participation in NCLEX review; access to computer lab; tutoring)

Nursing faculty - theory and clinical

  • Become familiar with NCLEX validity and practice-relatedness; include in orientation of new faculty
  • Use NCLEX Detailed Test Plan to validate curriculum; use as reference in curriculum development, revision, maintenance (conduct content mapping/comparative analysis of curriculum with Detailed Test Plan)
  • Participate in item-writing workshops

This information is provided by the Division of Health Professions Licensure within the Department of Public Health.

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