APA reference

Simon, E. B., & Joseph, S. (2023). NCLEX-RN First-Time Passing Predictors. Journal of the New York State Nurses Association, 50(1), 18–23.

Purpose

The research question was: What were the academic predictors of the first attempt pass/fail on the NCLEX-RN, and was there a statistically significant correlation between the specific breeds of nursing courses?

Hypothesis or Research Question

The two research questions associated with the research were:

What are the academic predictors of the first attempt pass/fail on the NCLEX-RN of new graduate nurses?

What is the correlation that exists between the first-attempt pass rates of the NCLEX-RN and the individual courses?

Theoretical Framework

The theory on which the study was based was the General Systems Theory (GST). The nursing program was considered as a system that is within the framework of:

Input: Student information and admissions (e.g., TEAS scores, GPA).

Throughput: Education (e.g., clinical courses, mentoring, remediation) processes and support systems.

Output: The result of the program (i.e., pass/fail first-time NCLEX-RN).

Feedback Loops: The system has feedback mechanisms as part of it, such as remediation. The research was focused on the input variables and the impact of these variables on the output.

Research Design

This study was a quantitative, correlational, and retrospective study. It used archived academic data of nursing students to identify the academic predictors of first-time NCLEX-RN passing or failing. The data were examined to examine the relationships between course grades, GPA, and NCLEX-RN success.

Statistical Methods

The data about the participants were summarized using descriptive statistics (means, standard deviations, frequencies). The correlation analysis and multiple regression by Pearson assessed the correlation between academic variables (e.g., GPA, TEAS scores, grades in specific courses) and NCLEX-RN outcomes. The independent-samples t-tests were used to compare the mean scores of the pass and fail groups.

Variables

 A. Dependent NCLEX-RN first-time pass/fail outcome.

B. Independent –

            Pre-admission academic predictors (e.g., TEAS composite score, cumulative GPA).

Observation on coursework in particular nursing areas (e.g., Medical-Surgical Nursing, Pediatrics, Pharmacology).

Overall program GPA.

Setting / Population / Sample

The research was done in a baccalaureate nursing school located in the Northeastern part of the United States.

Population: Newly graduated nurses who are eligible for the NCLEX-RN.

Sample: The convenience sample of 2017-2021 graduates with available academic and NCLEX-RN data (about n = 120-150, according to the comparable institutional research).

Inclusion criteria: Graduates who took the program and took the NCLEX-RN within six months of leaving the program.

Exclusion factors: students who failed to sit NCLEX-RN during the study period or had incomplete academic records.

Validity / Reliability

Internal validity is evidenced in the study by the use of objective archival data (e.g., GPA, TEAS scores, course grades, NCLEX outcomes), which reduces the effects of self-reporting in the study. The statistical validity is achieved through the use of Pearson correlation analysis and multiple regression analysis, which are relevant in testing the relationship between continuous variables. Construct validity is realized when predictors are correlated with predetermined measures of academic performance (i.e., GPA, standardized test scores).

Institutional records are used to increase reliability by way of using standard grading systems. Nevertheless, external reliability can be less as the criteria used to grade or the rigor of the course can differ across cohorts. The retrospective study design and single-site dataset do not allow one to control confounding variables like student motivation or personal stressors that could have an impact on NCLEX performance.

Generalizability

The generalizability is moderate in the context of similar baccalaureate nursing programs in the United States. The results of the study can be applicable to programs that have similar admission criteria, curriculum, and NCLEX preparation activities. Nevertheless, variations in program design, student population, and local testing are support services, limiting wide generalization. The sample size selected was a sample of one, Northeastern University, which curtails the extraneous validity in different nursing institutions or associate degree programs.

Findings

·       The variables of academic performance, including program GPA and course grades in core nursing courses (Medical-Surgical, Pharmacology, and Pediatrics), were important predictors of NCLEX-RN first-time success (p <.05).

·       There was also a positive correlation between TEAS composite scores and NCLEX-RN pass rates, though this was less so than in-program GPA.

·       Students who had GPAs [?] 3.25 were much more likely to pass the first attempt as compared to those with low averages.

·       Regression analyses revealed that the overall performance in the Medical-Surgical Nursing courses made the strongest prediction of NCLEX examination success.

·       Gender or age differences in pass/fail did not statistically differ.

·       Altogether, the performance in the academic program in the nursing background was the most reliable and consistent measure of NCLEX-RN performance.

Implications of the research for

a.     nursing

b.     education

c.     policy making

a. Nursing Practice:

• Emphasizes the role of academic preparedness in achieving nursing competency and patient safety in the initial practice placement.
• Facilitates early interventions and correction of at-risk students to avoid future workforce deficits.
• Promotes the correspondence between clinical decision-making competencies assessed by NCLEX-RN with nursing curricula.

b. Nursing Education:

• Certifies GPA and course performance as sound academic standards of NCLEX preparedness.
• Suggests evidence-based early intervention systems- which may include tutoring, sim lab, and adaptive testing- to reinforce student performance.
• Recommends the incorporation of NCLEX-type testing in the course of study to support learning based on application.
• Facilitates ongoing review of curriculum to make sure that difficult courses (e.g., Pharmacology) get due instructional attention.

c. Policy Making:

• Endorses evidence-based admission and advancement policies that focus on academic portents (e.g., minimum GPA, standardized test cutoffs).
• Recommends that nursing boards and accrediting agencies require continuous evaluation of their programs based on NCLEX predictor measures.
• Confirms the distribution of resources to academic support programs aimed at retaining and licensure preparation of students.
• Recommends policy-level rewards to institutions with a stable NCLEX pass rate improvement.

Limitations

·       Single-site retrospective study, which restricts extrapolation of external validity to other locations or institutions.

·       A small sample ([?]120-150) decreases the statistical power of subgroup analysis.

·       The possible confounding variables (test anxiety, socioeconomic background, and study habits) were not measured using regression models.

·       Use of archived academic data on reliance excludes non-academic factors such as emotional intelligence or drive, or clinical prudence.

·       The absence of longitudinal follow-up does not allow assessment of the predictive factors showing how they change with time or influence professional practice.

·       There is no research on the institutional quality of teaching or curriculum variation that could be a mediator between academic results.

Bias

The retrospective design has information and selection bias, as the information was founded on existing academic documents. The information within the single-sites can be representative of institutionalism of grading, which introduces institutional bias. Non-academic variables (motivation, stress, testing conditions), which can be highly significant, are not assessed, which brings about omitted-variable bias. Convenience sampling can also limit the representativeness.

Recommendations

Use early academic intervention to identify underachieving students by their GPA and major subject performance. Make improvements in remediation, tutoring, and NCLEX-type testing across the curriculum. The decisions on admission and progression must be calculated using data. Enhance research to multi-site prospective research in order to raise the level of generalizability.

Synthesis of the article

This study reveals that academic performance, especially the GPA and major subject scores are major predictor of first-time NCLEX results. The indicators of a pre-admission are significant but not as strong as the in-program performance. Overall, the research gives preference to the implementation of academic standards and interventions to improve licensure preparedness.

Is this a valuable article for EBP? Why or why not?

Yes, it is practical because it provides objective data-based evidence on academic predictors of NCLEX performance that is critical regarding educational planning and support of students. Despite the limitations posed by the one-site nature of the results, they offer some practical suggestions on how to improve the results of the programs and the policies of reinforcement.