Self-rated professional competence and well-being at work after obtaining a Swedish nursing license: A longitudinal mixed-methods study of internationally and domestically educated nurses.

BACKGROUND: An inclusive workplace is where everyone is supported to thrive and succeed regardless of their background. Supportive working conditions and general self-efficacy have been found to be important for nurses' perceived competence and well-being at work, however, in the context of being a nurse in a new country, research is limited. Moreover, knowledge is lacking about whether different paths to a nursing license are related to nurses' perceived competence and well-being when working. OBJECTIVE: To examine determinants and experiences of nursing competence and well-being at work (thriving and stress) among internationally and domestically educated nurses. DESIGN: A longitudinal descriptive and correlational design with a mixed-methods convergent approach was used. METHODS: A longitudinal study was conducted between January 2019 and June 2022 with two groups of internationally educated nurses who had completed a bridging program or validation to obtain a Swedish nursing license and one group of domestically newly educated nurses. Data were collected on three occasions: Time1 at the end of the nursing licensure process (n = 402), Time2 after three months (n = 188), and Time3 after 12 months (n = 195). At Time3, 14 internationally educated nurses were also interviewed. Data were analyzed separately and then interpreted together. RESULTS: Multiple regression models showed that greater access to structural empowerment (B = 0.70, 95 % CI [0.31; 1.08]), better cooperation (B = 3.76, 95 % CI [1.44; 6.08]), and less criticism (B = 3.63, 95 % CI [1.29; 5.96]) were associated with higher self-rated competence at Time3, whereas the variable path to a nursing license was non-significant (R2 = 49.2 %). For well-being, greater access to structural empowerment (B = 0.07, 95 % CI [0.02; 0.12]), better cooperation (B = 0.36, 95 % CI [0.07; 0.66]) and being domestically educated (B = 0.53, 95 % CI [0.14; 0.92]) were associated with higher thriving at work (R2 = 25.8 %). For stress, greater access to structural empowerment (B = -0.06, 95 % CI [-0.09; -0.02]), better cooperation (B = -0.30, 95 % CI [-0.51; -0.10]), and less criticism (B = -0.28, 95 % CI [-0.46; -0.05]) were associated with having symptoms less frequently while being domestically educated was associated with having stress symptoms more often (B = 0.44, 95 % CI [0.07; 0.81]) (R2 = 43.3 %). Higher general self-efficacy at Time1 was associated with higher self-rated competence at Time2 (B = 4.76, 95 % CI [1.94; 7.59]). Quantitative findings concurred with findings from interviews with internationally educated nurses. However, qualitative findings also highlighted the importance of previous education, working experience, the new context, and communication abilities. CONCLUSIONS: Both quantitative and qualitative data showed that working conditions were important for nurses' self-rated competence and well-being at work. Although communication difficulties, previous education, and working experience were not statistically significant in the multiple regression models, in the interviews these factors emerged as important for internationally educated nurses' competence and well-being.

Social processes influencing nursing students in passing the nursing licensure examination: A grounded theory approach.

AIM: To explore the strategies used by nursing students in passing the nursing licensure examination. DESIGN: This study uses a classic grounded theory design to explore the social processes influencing a nursing license examination. METHODS: Eight graduate students participated in this research study and were interviewed in-depth twice. The Classic Grounded Theory method of Glaser was applied to collect and analyse the data until saturation was reached. RESULTS: The findings revealed that students who passed the nursing licensure examination described the strategies as a preliminary model comprising a core category, Reviewing (Phase 1), which consisted of two sub-categories: Entering Time and Reviewing Styles. Additionally, two other main categories emerged: the Tutoring category (Phase 2) and the Testing Practice category (Phase 3). It was observed that each course (subject) does not necessarily follow a specific order in traversing these phases; they may move back and forth between them until the conclusion of the examination. Furthermore, it was found that the time allocated to Entering Time and completing the three phases significantly influences the successful passing of the nursing licensure examination.

Faculty Development on the Use of a Clinical Judgment Model in the Pre-licensure Nursing Curriculum.

Clinical judgment is an essential component of safe nursing practice that pre-licensure nursing students should develop by graduation from accredited nursing programs. For novice nurses, the consequences of underdeveloped clinical judgment skills that do not meet the demands of clinical practice are serious. This theory-practice gap correlates with increased numbers of errors occurring during care delivery, resulting in poorer patient outcomes. From a student perspective, this problem correlates with lower first-time pass rates on the NCLEX licensing exam. For nurse educators, there are uncertainties about how to resolve this complex and costly problem, but faculty development is one evidence-based solution to explore. The purpose of this article is to describe a three-pronged quality improvement project consisting of: 1) a faculty development session to teach faculty to implement the National Council State Boards of Nursing's Clinical Judgment Model (CJM) in their courses; 2) the use of the Clinical Judgment Tool; and 3) the implementation of a faculty champion to sustain and maintain ongoing faculty momentum to foster clinical judgment. This article focuses on how faculty can develop their own CJM faculty development session and use a CJM across the course curriculum.

Evolving Licensure Examination: Assessing Student Confidence and Accuracy With Next Generation NCLEX.

BACKGROUND: The Next Generation NCLEX (NGN) includes new item types. Little is known about nursing students' confidence and accuracy in answering these questions. METHOD: A descriptive comparative study examined prelicensure nursing students' confidence and accuracy in answering NGN-style items versus multiple-choice questions (MCQs) of the same content via a 12-item quiz. RESULTS: Less than one third of students (n = 194; 32.1%) reported feeling confident in answering NGN questions. Students' confidence levels had no relationship on scores with NGN items. When comparing NGN-style items to MCQs, students' (n = 221) scores on NGN-style items were lower with bowtie or a select-all-that-apply questions but higher with highlight table or matrix multiple-choice questions. CONCLUSION: Students' lack of confidence with certain item types suggests faculty should incorporate these item types into classroom activities or course assignments. NGN test-taking strategies also should be incorporated and frequently reinforced throughout the curriculum. [J Nurs Educ. 2024;63(4):252-255.].

The effectiveness of badging systems in engaging, motivating, and incentivizing students in the mastery of nursing licensure materials.

INTRODUCTION: Integrating gamification methods into undergraduate nursing programs has prepared students to pass the nursing comprehensive predictor test and the licensure examination. LITERATURE REVIEW: Research demonstrates that the motivational factors of game elements like badging and leaderboards are of great value and utility to student engagement and motivation. The badges symbolize achievement, authority, and belonging, whereas leaderboards rank students based on different levels of course engagement. DISCUSSION: This paper explores the benefits, challenges, and strategies of incorporating digital badges and leaderboards in the undergraduate program. Immersion courses preparing students for professional practice are usually one of the last didactic courses offered in the undergraduate curriculum, designed to integrate all knowledge gained from the nursing program. IMPLICATIONS FOR AN INTERNATIONAL AUDIENCE: The digital badging system can encourage nurse educators globally to engage, motivate, and power students to achieve professional goals. Furthermore, nursing programs worldwide can benefit from adding digital badges and leaderboards to final semester preparatory courses or any nursing course with the same emphasis. CONCLUSIONS: Digital badges and leaderboards engage and motivate students to integrate knowledge and skills learned in the nursing program and successfully master nurse licensure materials.

An Overview of Nursing Regulation.

The rules and regulations that govern nursing practice are topics rarely covered in nursing education programs. This article aims to provide a basic understanding of state and federal rules that govern nursing practice; the role and duties of nurse regulatory boards; types of legal actions that nurses may face; and an overview of discipline, complaint, and reporting processes.

An NCLEX-RN Improvement Project: A Study of Student Attributes Associated With Test Success.

BACKGROUND: A school of nursing developed a process to improve graduates' NCLEX-RN scores through a committee tasked with identifying approaches to assist students in passing the NCLEX-RN on the first attempt. METHOD: The process involved: (1) engaging the faculty to use current published evidence; and (2) conducting an anonymous survey of previous graduates to identify the factors associated with NCLEX-RN success in the school's student population. Logistic regression analysis was conducted on a sample of 165 graduates of the program. RESULTS: The analysis of the graduates' psychosocial, academic, and NCLEX-RN preparation attributes compared with NCLEX-RN outcome revealed grade point average was the strongest significant predictor of success. CONCLUSION: The NCLEX-RN success program served to engage the school of nursing faculty. In addition, a study of the program's graduates revealed a predictor of potential student success that can identify students who may need additional support early in the program. [J Nurs Educ. 2024;63(2):102-107.].

Assessing question characteristic influences on ChatGPT's performance and response-explanation consistency: Insights from Taiwan's Nursing Licensing Exam.

BACKGROUND: Investigates the integration of an artificial intelligence tool, specifically ChatGPT, in nursing education, addressing its effectiveness in exam preparation and self-assessment. OBJECTIVE: This study aims to evaluate the performance of ChatGPT, one of the most promising artificial intelligence-driven linguistic understanding tools in answering question banks for nursing licensing examination preparation. It further analyzes question characteristics that might impact the accuracy of ChatGPT-generated answers and examines its reliability through human expert reviews. DESIGN: Cross-sectional survey comparing ChatGPT-generated answers and their explanations. SETTING: 400 questions from Taiwan's 2022 Nursing Licensing Exam. METHODS: The study analyzed 400 questions from five distinct subjects of Taiwan's 2022 Nursing Licensing Exam using the ChatGPT model which provided answers and in-depth explanations for each question. The impact of various question characteristics, such as type and cognitive level, on the accuracy of the ChatGPT-generated responses was assessed using logistic regression analysis. Additionally, human experts evaluated the explanations for each question, comparing them with the ChatGPT-generated answers to determine consistency. RESULTS: ChatGPT exhibited overall accuracy at 80.75 % for Taiwan's National Nursing Exam, which passes the exam. The accuracy of ChatGPT-generated answers diverged significantly across test subjects, demonstrating a hierarchy ranging from General Medicine at 88.75 %, Medical-Surgical Nursing at 80.0 %, Psychology and Community Nursing at 70.0 %, Obstetrics and Gynecology Nursing at 67.5 %, down to Basic Nursing at 63.0 %. ChatGPT had a higher probability of eliciting incorrect responses for questions with certain characteristics, notably those with clinical vignettes [odds ratio 2.19, 95 % confidence interval 1.24-3.87, P = 0.007] and complex multiple-choice questions [odds ratio 2.37, 95 % confidence interval 1.00-5.60, P = 0.049]. Furthermore, 14.25 % of ChatGPT-generated answers were inconsistent with their explanations, leading to a reduction in the overall accuracy to 74 %. CONCLUSIONS: This study reveals the ChatGPT's capabilities and limitations in nursing exam preparation, underscoring its potential as an auxiliary educational tool. It highlights the model's varied performance across different question types and notable inconsistencies between its answers and explanations. The study contributes significantly to the understanding of artificial intelligence in learning environments, guiding the future development of more effective and reliable artificial intelligence-based educational technologies. TWEETABLE ABSTRACT: New study reveals ChatGPT's potential and challenges in nursing education: Achieves 80.75 % accuracy in exam prep but faces hurdles with complex questions and logical consistency. #AIinNursing #AIinEducation #NursingExams #ChatGPT.

Preparing Nurse Educator Students for the New National Council of State Boards of Nursing NCLEX and AACN Essentials.

BACKGROUND: Graduate nursing education students are required to complete essential core content (such as education theory, accreditation, evidence-based teaching strategies, and evaluation methods) to prepare them to transition into independent practice. The 2021-2022 academic year required a monumental change in the existing curriculum to incorporate the 2021 American Association of Colleges of Nursing Essentials and the Next Gen National Council Licensure Examination (NCLEX) content. METHOD: An innovative, prioritized, learner-centered, backward design was used to update the existing curriculum to add the new core content to the nursing education student curriculum. RESULTS: The end of program comprehensive exams revealed that the students were able to successfully develop a test blueprint, utilizing case studies with Next Gen NCLEX question types designed to measure clinical judgment, and map to the 2021 AACN Essentials. CONCLUSION: The timely implementation of the curriculum revisions resulted in the achievement of desired student learning outcomes. [J Nurs Educ. 2024;63(3):192-196.].

Comparative Analysis of NCLEX-RN Questions: A Duel Between ChatGPT and Human Expertise.

BACKGROUND: Artificial intelligence (AI) has the potential to revolutionize nursing education. This study compared NCLEX-RN questions generated by AI and those created by nurse educators. METHOD: Faculty of accredited baccalaureate programs were invited to participate. Likert-scale items for grammar and clarity of the item stem and distractors were compared using Mann-Whitney U, and yes/no questions about clinical relevance and complex terminology were analyzed using chi-square. A one-sample binomial test with confidence intervals evaluated participants' question preference (AI-generated or educator-written). Qualitative responses identified themes across faculty. RESULTS: Item clarity, grammar, and difficulty were similar for AI and educator-created questions. Clinical relevance and use of complex terminology was similar for all question pairs. Of the four sets with preference for one item, three were generated by AI. CONCLUSION: AI can assist faculty with item generation to prepare nursing students for the NCLEX-RN examination. Faculty expertise is necessary to refine questions written using both methods. [J Nurs Educ. 2023;62(12):679-687.].

Effects of the COVID-19 Pandemic on Comprehensive Predictor Scores as Proxy for the NCLEX-RN.

BACKGROUND: Research is needed to examine whether the coronavirus disease 2019 (COVID-19) pandemic affected nursing students' NCLEX-RN pass rate. A decline in the NCLEX-RN pass rate would be detrimental to the nursing workforce, the nursing shortage, and nursing educational programs. This quantitative comparative study analyzed the effect of the COVID-19 pandemic on nursing students' Comprehensive Predictor scores as a proxy for the NCLEX-RN. METHOD: An independent t test was conducted to test for a difference in Comprehensive Predictor scores of nursing students before and during the COVID-19 pandemic. RESULTS: There was no statistically significant difference in Comprehensive Predictor scores before and during the pandemic. CONCLUSION: Because there was no significant change in nursing students' pass rate on the Comprehensive Predictor as a proxy for the NCLEX-RN during the COVID-19 pandemic, the number of new graduate nurses entering clinical practice is expected to remain the same as pre-pandemic levels. [J Nurs Educ. 2023;62(11):638-641.].

An audit of mental health questions on U.S. nursing licensure applications: Evidence to guide urgent action for change.

BACKGROUND: Nurses often forgo needed mental healthcare due to stigma and fear of losing their license. The decision to access care or disclose mental health struggles is intensified when registered nurses (RNs) or advanced practice registered nurses (APRNs) discover that licensure applications ask invasive mental health questions that could impact their ability to work. AIMS: This study highlights findings from an audit of mental health and substance use questions included in RN and APRN licensure applications across the United States. METHODS: A sequential 4-step approach was used to retrieve RN and APRN licensure applications: (1) review of Board of Nursing (BON) websites, (2) communication with BON staff, (3) communication with Deans of Nursing to ask for retrieval assistance, and (4) creation of mock applicants. An embedded checklist within the Dr. Lorna Breen Heroes Foundation's Remove Intrusive Mental Health Questions from Licensure and Credentialing Applications Toolkit guided the audit. Two study team members reviewed the applications independently for intrusive mental health questions, which were designated as non-compliant with the Toolkit's recommendations and arbitrated for consensus. States were designated as non-compliant if ≥1 item on the checklist was violated. RESULTS: At least one RN and APRN application was obtained from 42 states. Only RN applications were obtained from five states, while only APRN applications were obtained from three states. Only 13 states (26%) fully adhered to the Took-Kit checklist. LINKING EVIDENCE TO ACTION: The majority of BONs did not fully adhere to the Took-Kit checklist. Guidance from national organizations and legislation from state governments concerning the removal or revision of probing mental health and substance use questions is urgently needed to cultivate a stigma-reducing environment where nurses are supported in seeking needed mental health treatment.

Course repetition in pre-licensure nursing students: A scoping review.

SIGNIFICANCE OF PROBLEM: Nursing student attrition is a global issue affecting students, nursing programs, and the profession. One group of nursing students at risk for attrition are those that have failed and need to repeat a required nursing course. These students experience academic consequences such as delayed graduation and entry into the workforce, further contributing to the nursing shortage. Unfortunately, current literature about nursing student repeaters remains inadequate, and evidence of support measures is minimal. PURPOSE: This scoping review aims to summarize the literature on course repetition in pre-licensure nursing students and identify gaps in the literature about this population. METHODS: Arskey and O'Malley's (2005) five-step procedure was used as the organizing framework to explore course repetition in pre-licensure nursing students. RESULTS: There were twenty articles relevant for this scoping review. The findings revealed nursing student repeaters are at an increased risk for subsequent failure and attrition. Students experienced shock, sadness, and uncertainty when course failure ensued. Nursing students sought additional help while repeating failed courses, but interventions solely harnessed toward student repeaters can be beneficial. CONCLUSION: Nursing student repeaters are a unique population that requires a multifaceted approach, including academic and non-academic support structures, to ensure they meet the educational standards of the repeated course. Future studies regarding this population should include progression policies' impact on student success and strategies and interventions that create positive outcomes among student repeaters.